Question:
A 40 year-old female patient presents to the clinic with multiple, painful reddened nodules on the anterior surface of both legs. She is
... [Show More] concerned. These are probably associated with her history of:
deep vein thrombosis.phlebitis. Incorrectulcerative colitis. Correctalcoholism.
Explanation:
These nodules describe erythema nodosum. These are most common in women aged 15-40 years old. They are typically found in pretibial locations and can be associated with infectious agents, drugs, or systemic inflammatory disease like ulcerative colitis. They probably occur as a result of a delayed hypersensitivity reaction to antigens. It is not unusual to find polyarthralgia, fever, and or malaise that precede or accompany the skin nodules.
Question:
A patient reports that he found a tick on himself about one month ago. He reports that there is a red circle and a white center near where he remembers the tick bite. He did not seek treatment at the time. Today he complains of myalgias and arthralgias. What laboratory test can be used to help diagnose Lyme disease? CBCLyme titerELISA CorrectSkin scraping
Explanation:
A detailed history should always precede testing for Lyme Disease. The red circle with the white center is likely erythema migrans (EM). EM is the characteristic skin lesion of Lyme Disease (and other illnesses) and usually occurs within one month following the tick bite. Many learned authorities including the Infectious Diseases Society of America conclude that individuals should not be screened/tested for Lyme disease unless they have a high probability of having Lyme disease. In this case, historical features coupled
with physical exam support the diagnosis, and thus screening. The most common initial serologic test for screening is an ELISA. If it is positive, it should be confirmed with a Western blot. Unfortunately, there are a large number of false positives and so a confirmation should be performed
Question:
An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed by the dermatologist. The adolescent arrives in your clinic with a sinus infection. Her temperature is 99.5 degrees F and her blood pressure is 160/100. How should this be managed?
Call the dermatologist to report the elevated BP CorrectTreat the sinus infection and recheck the BP in one week IncorrectDiscontinue the isotretinoin todayDiscontinue the oral contraceptive today
Explanation:
The nurse practitioner is responsible for treating the sinus infection but has also become aware of a potentially harmful situation involving the elevated blood pressure and oral contraceptive use. The safest and most professional action is to call the dermatologist to discuss your concerns regarding the elevated BP and concomitant oral contraceptive use since this potentially increases the risk of stroke in this adolescent. Care and professional courtesy should be exercised when discontinuing a medication that another provider has initiated. Professional courtesy is extended to the prescriber by calling them prior to discontinuing a medication they have ordered.
Question:
The agent commonly used to treat patients with scabies is permethrin. How often is it applied to eradicate scabies?
Once CorrectOnce daily for 3 daysTwice daily for 3 daysOnce daily for one week Incorrect
Explanation:
A single whole body application of permethrin is usually successful in eradicating infection with scabies. It is applied over the entire body from the neck down. The lotion is left on and then showered off 8-12 hours later. All contacts must be treated at the same time and all potential fomites (bed linen, mattresses, cloth furniture, etc.) must be treated as well. Permethrin can be sprayed on cloth fomites or they can be bagged for several days, washed and dried in washing machine and dryer. Ironing clothes after washing them is acceptable.
Question:
An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a: moisture barrier like zinc oxide.topical anti-fungal agent. Correcttopical anti-bacterial agent.low potency steroid cream.
Explanation:
The finding of satellite lesions associated with diaper dermatitis indicates a Candidal infection. This patient will be most effectively treated with a topical anti-fungal agent, allowing the lesions to be exposed to air for periods of time (like during a nap). A moisture barrier like zinc oxide is more beneficial when the diaper dermatitis is due to irritants like prolonged exposure to urine or feces. A low potency steroid cream should be used with caution in an infant with a fungal infection. A low potency cream in conjunction with an anti- fungal can be helpful if there is a great amount of underlying inflammation but has the potential to worsen the infection.
Question:
A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? Doxycycline CorrectAmoxicillin-clavulanateTrimethoprim-sulfamethoxazoleCephalexin Explanation:
Doxycycline is frequently chosen first line to treat Lyme Disease. However, numerous studies have demonstrated that amoxicillin and cefuroxime have equal efficacy as doxycycline in treatment of early Lyme Disease. These drugs are recommended in patients who exhibit erythema migrans. Doxycycline is not recommended in children less than 9 years of age
Question: [Show Less]