APEA 3P Exam Prep- Dermatology question with answers 100% correctImpetigo is characterized by:
honey-colored crusts.
silvery scales.
marble-like
... [Show More] lesions.
wheals with pus.
A.
Impetigo is a superficial bacterial infection of the skin characterized by honey-colored crusts. Another form of impetigo is characterized by the presence of bullae. These infections are treated with topical antibiotics, good hygiene, and frequent hand washing. It is usually caused by Staphylococcus or Group A Streptococcus.
A patient was burned with hot water. He has several 2-3 cm fluid-filled lesions. What are these termed?
Vesicles
Bullae
Cysts
Wheals
B.
Bullae are fluid-filled lesions that are greater than 6 mm in diameter. These are common in patients who have a superficial partial-thickness burn. Vesicles are also fluid filled, but they are smaller than 5 mm in diameter. A cyst is enclosed in a sac that can contain fluid or gelatinous material. Wheals are erythematous, irregular raised areas on the skin. All of these are termed primary lesions.
The best way to evaluate jaundice associated with liver disease is to observe:
blanching of the hands, feet, and nails.
the sclera, skin, and lips.
the lips, oral mucosa, and tongue.
tympanic membrane and skin only.
B.
Looking at the sclera allows the examiner to see jaundice most easily and reliably. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin. Jaundice in adults usually is a result of liver disease, but it can be due to excessive hemolysis of red blood cells. In infants, the usual cause is hemolysis of red blood cells, as is seen in physiologic jaundice.
The most common place for a basal cell carcinoma to be found is the:
scalp.
Face.
Ear.
Anterior shin.
B.
The most common presentation of basal cell carcinoma (BCC) is on the face. This is probably because BCC occurs secondary to sun damage. The most common sun exposure occurs on the face. In fact, 70% of BCC occurs on the face; 15% occurs on the trunk.
A topical treatment for basal cell carcinoma is:
sulfacetamide lotion.
5-fluorouracil.
tetracycline lotion.
trichloroacetic acid.
B.
Several treatments exist for basal and squamous cell carcinoma. The majority are simple procedures like cryotherapy, electrodessication, surgical excision, and a topical treatment like 5-fluorouracil (5-FU). The other agents listed are not used to treat basal or squamous cell carcinoma. 5-FU works by inhibiting DNA synthesis. It is effective if used for superficial basal cell carcinomas. It is available in cream and solution and is usually applied twice daily for 3-6 weeks.
A 74-year-old male patient has sustained a laceration to his foot. His last tetanus shot was more than 10 years ago. He has completed the primary series. What should be recommended?
Tetanus toxoid only
Tetanus and diphtheria only
His primary series will protect him.
Tetanus, diphtheria, and acellular pertussis (Tdap)
D.
More than 10 years has elapsed since this patient’s last tetanus shot. He needs another one. Tdap is specifically indicated for adolescents, older adults, healthcare providers, and third trimester pregnant patients who have completed a primary series. Tetanus toxoid is indicated in the rare adult or child who is allergic to the aluminum adjuvant in the Td immunization.
7- A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small vesicles on the palmar surface of the hand. What is this called?
Seborrheic dermatitis
Dyshidrotic dermatitis
Herpes zoster
Varicella zoster
B.
This dermatitis is intensely pruritic and involves the palms and soles and lateral aspects of the fingers. Over a couple of weeks, the vesicles desquamate. Recurrences are common. Seborrheic dermatitis affects only hairy areas of the body. The vesicles might raise suspicion of a viral infection, but this is not present in this case.
A 71-year-old female presents with a vesicular rash that burns and itches. Shingles is diagnosed. An oral antiviral:
should be started within 72 hours of the onset of symptoms.
must be started within 96 hours of the onset of the rash.
can be started at any time after the appearance of the rash.
will nearly eliminate the risk of postherpetic neuralgia.
A.
This patient has been diagnosed with shingles. This can produce painful neuritis. Shingles is treated with an oral antiviral agent, preferably within 72 hours of onset of the symptoms. Treating shingles with an oral antiviral agent shortens the severity and duration of shingles. It may also help decrease the incidence of post-herpetic neuralgia.
A patient presents with plaques on the extensor surface of the elbows, knees, and back. The plaques are erythematous and thick, silvery scales are present. This is likely:
plaque psoriasis.
guttate psoriasis.
atopic dermatitis.
Staph cellulitis.
A.
Plaque psoriasis is seen initially in young adults and is characterized as described above. The thick, silvery scale is pathognomic and is usually asymptomatic, but some patients will complain of pruritus. A clinical finding that will help establish a diagnosis is the pitting of fingernails. This occurs in about 50% of patients with psoriasis. The plaques are commonly distributed on the scalp, and extensor surface of the elbows, knees, and back. This is a chronic skin disorder.
An example of a premalignant lesion that develops on sun-damaged skin is:
actinic keratosis.
basal cell carcinoid.
squamous cell carcinoma.
molluscum contagiosum.
A.
Actinic keratoses (AK) are a result of solar damage to the skin. They are most common on the face, bald scalp, and forearms. Patients who present with AK usually have multiple of them. A characteristic that helps identification of AK is an area of erythema that surrounds the lesion. AK is sometimes easier felt than seen.
A patient has been in the sun for the past few weeks and has developed darkened skin and numerous 3-6 mm light-colored, flat lesions on his trunk. What is the likely etiology?
Tinea corporis
Tinea unguium
Tinea versicolor
Human papilloma virus
C.
Tinea versicolor is typically visualized during the spring and summer months when a patient has become darkened after sun exposure. The areas that are infected do not tan and so become very noticeable. The chest and back are common areas to observe tinea versicolor. There can be 100 or more in some infections. This can be treated with topical selenium sulfide or an oral antifungal agent.
A patient with a primary case of scabies was probably infected:
1-3 days ago.
1 week ago.
2 weeks ago.
3-4 weeks ago.
D.
The incubation period for scabies is about 3-4 weeks after primary infection. Patients with subsequent infections with scabies will develop symptoms in 1-3 days. The classic symptom is itching which is worse at night, coupled with a rash that appears in new areas over time.
A patient presents to the minor care area of the emergency department after being bitten by a dog. The patient states that the dog had a tag around his neck and had been seen roaming around the neighborhood for days before the patient was bitten. The dog did not exhibit any odd behavior. How should this be managed?
If the bites are only minor, do not mention rabies prophylaxis to the patient.
Give the patient tetanus immunization only. Don’t call animal control.
Clean the wounds, provide tetanus and rabies prophylaxis.
Report the bite to animal control and administer appropriate medical care.
D.
All 50 states require reporting of animal bites to animal control or the state’s appropriate authority for reporting animal bites. It sounds unlikely that the dog could be infected with rabies, but rabies prophylaxis must be considered after all history and information has been gathered.
A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer with red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe?
Stage I
Stage II
Stage III
Stage IV
B.
Stage I is characterized by intact skin and non-blanchable redness of a localized area (usually over a bony prominence). Compared to adjacent tissue, the area may be painful, firm, soft, warmer or cooler.
Stage II is characterized by partial-thickness loss of dermis presenting as a shallow open ulcer or a red-pink wound bed, absent sloughing. It may also present as an intact or open/ruptured serum-filled blister.
Stage III is characterized by full-thickness tissue loss with or without visible subcutaneous fat; bone, tendon, and muscle are not exposed. Sloughing may be present but does not obscure the depth of tissue loss. The depth varies by anatomical location.
Stage IV is characterized by full-thickness tissue loss with exposed bone, tendon, or muscle. Sloughing or eschar may be present on some parts of the wound bed. The depth varies by anatomical location.
The nurse practitioner examines a patient who has had poison ivy (hiedra venenosa) for 3 days. She asks if she can spread it to her family members. The nurse practitioner replies:
“Yes, but only before crusting has occurred.”
“Yes, the fluid in the blister can transmit it.”
“No, the transmission does not occur from the blister’s contents.”
“No, you are no longer contagious.”
C.
The skin reaction seen after exposure to poison ivy (hiedra venenosa), takes place because of contact with the offending substance. In the case of poison ivy, the harmful exposure occurs from contact with oil from the plant. The eruptions seen are NOT able to transmit the reaction to other people unless oil from the plant remains on the skin and someone touches the oil. The fluid found in the blisters is NOT able to transmit poison ivy to anyone; only the oil from the plant can do that. After the oil has touched the skin, some time must pass for the reaction to occur. Therefore, reaction times vary depending on skin thickness and the quantity of oil contacting the skin.
A “herald patch” is a hallmark finding in which condition?
Erythema infectiosum
Pityriasis rosea
Seborrheic keratosis
Atopic dermatitis
B.
Pityriasis rosea (PR) is a self-limiting exanthematous skin disorder characterized by several unique findings. It is more common in young adults. A characteristic finding is the “herald” or “mother” patch found on trunk. This looks like a ringworm and precedes the generalized “Christmas tree” pattern rash. The lesions associated with the rash are salmon-colored and oval in shape. Most cases clear in 4-6 weeks, but the plaques may last for several months.
A 74-year-old woman is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed?
An oral antiviral agent
An oral antiviral agent plus an oral steroid
An oral antiviral agent plus a topical steroid
A topical steroid only
A.
An oral antiviral agent such as acyclovir, famciclovir or valacyclovir should be prescribed, especially if it can be initiated within 72 hours after the onset of symptoms. The addition of oral corticosteroids to oral antiviral therapy demonstrates only modest benefits. Adverse events to therapy are more commonly reported in patients receiving oral corticosteroids. There is no evidence that corticosteroid therapy decreases the incidence or duration of postherpetic neuralgia or improves the quality of life. Corticosteroids should be limited to use in patients with acute neuritis who have not derived benefits from opioid analgesics.
An example of a first-generation cephalosporin used to treat a skin infection is:
cephalexin.
cefuroxime.
cefdinir.
cefaclor.
A.
Two common first-generation cephalosporins used to treat skin and skin structure infections are cephalexin and cefadroxil. These are taken two to four times daily and are generally well tolerated. These antibiotics provide coverage against Staphylococcus and Streptococcus, common skin pathogens.
A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate:
hyphae.
yeasts.
rods or cocci.
a combination of hyphae and spores.
A.
Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are usually seen in candidal infections. Cocci and rods are specific to bacterial infections.
A patient has been diagnosed with MRSA. She is allergic to sulfa. Which medication could be used to treat her?
Augmentin
Trimethoprim-sulfamethoxazole (TMPS)
Ceftriaxone
Doxycycline
D.
MRSA is methicillin-resistant Staph aureus. This is very common in the community and is typically treated with sulfa medications like TMP/SMX (Bactrim DS and Septra DS). If the patient is allergic to sulfa, this should not be used. A narrow-spectrum antibiotic that can be used is doxycycline or minocycline. It is given twice daily and is generally well tolerated. MRSA is resistant to the antibiotics in the other choices and so they should NOT be used to treat it. [Show Less]