APEA 3P Exam
#1 risk factor for COPD - ANS smoking
Acanthosis Nigricans: symptoms - ANS 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 - ANS -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) - ANS Category X:
Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
Acne Rosacea - ANS 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 - ANS First line is always topical
retinoid such as tretinoin cream (Retin-A)
Acne: Mild treatmetn - ANS 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) - ANS 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 - ANS 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 - ANS
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 - ANS 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 - ANS 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 - ANS Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANS 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 - ANS 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 - ANS 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 - ANS 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
Treatment: NO antibiotic use in the prior month: o Amoxicillin high dose (first line):
1000 mg TID x 5-7 days
Next antibiotic choices are: 23
Augmentin x 5-7 days o Omnicef or cefpodoxime BID x 5-7 days
Penicillin Allergy: Type 1 Allergy (anaphylaxis, angioedema): Levofloxacin 750 mg
QD x 5-7 days OR Doxycycline BID x 5-7 days • Type 2 Allergy (skin rash): Omnicef,
cefpodoxime, Ceftin BID x 5-7 days
#1 risk factor for COPD - ANS smoking
Acanthosis Nigricans: symptoms - ANS 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 - ANS -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) - ANS Category X:
Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
Acne Rosacea - ANS 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 - ANS First line is always topical
retinoid such as tretinoin cream (Retin-A)
Acne: Mild treatmetn - ANS 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) - ANS 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 - ANS 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 - ANS
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 - ANS 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 - ANS 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 - ANS Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANS 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 - ANS 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 - ANS 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 - ANS 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
Treatment: NO antibiotic use in the prior month: o Amoxicillin high dose (first line):
1000 mg TID x 5-7 days
Next antibiotic choices are: 23
Augmentin x 5-7 days o Omnicef or cefpodoxime BID x 5-7 days
Penicillin Allergy: Type 1 Allergy (anaphylaxis, angioedema): Levofloxacin 750 mg
QD x 5-7 days OR Doxycycline BID x 5-7 days • Type 2 Allergy (skin rash): Omnicef,
cefpodoxime, Ceftin BID x 5-7 days
