Question:
What advice should be given to a parent who has a child with Fifth Disease?
This commonly causes pruritis in young children.He can return to
... [Show More] school when the rash has disappeared.Acetaminophen should be avoided in this child. IncorrectA parent may experience joint aches and pains. Correct
Explanation:
Fifth disease, erythema infectiosum, is a common viral exanthem seen in children 5-15 years of age. This produces a maculopapular rash that blanches easily. This rash is not pruritic but may last for several weeks before it completely goes away. Children are allowed to attend school as long as they have been fever free for 24 hours. Discomforts of this illness (fever, body aches, etc.) may be treated with acetaminophen or ibuprofen. Adults who are exposed to children with Fifth Disease can complain of arthralgias and myalgias for several weeks.
Question:
A low potency topical hydrocortisone cream would be most appropriate in a patient who has been diagnosed with:
psoriasis.impetigo.cellulitis.atopic dermatitis. Correct
Explanation:
Low potency steroid creams are almost never potent enough to treat psoriasis. These require higher potency steroid preparation or systemic agents. Impetigo is a superficial bacterial infection and a steroid cream would be contraindicated. Cellulitis is an infection of the subcutaneous layer of the skin and requires an oral or systemic antibiotic. Atopic dermatitis is a chronic inflammatory disorder of the skin that involves a genetic defect in the proteins supporting the epidermal layer. A patient with atopic dermatitis would be the most appropriate (of those listed above) to use a low potency topical steroid cream.
Question:
Mr. Johnson is a 74 year old who presents with a pearly-domed nodular looking lesion on the back of the neck. It does not hurt or itch. What is a likely etiology?
Basal cell carcinoma CorrectSquamous cell carcinoma IncorrectMalignant melanomaActinic keratosis
Explanation:
Basal cell’s classic description is “a pearly domed nodule with a telangiectatic vessel”. It is commonly found on sun-exposed areas like the head or neck. Sending the patient to dermatology (since these represent skin cancer) best treats these lesions. Sometimes these lesions can be treated with a topical agent like 5- fluorouracil, but others require surgical intervention.
Question:
A patient is found to have koilonychia. What laboratory test would be prudent to perform?
Liver function testsComplete blood count CorrectHepatitis B surface antigenArterial blood gases
Explanation:
Koilonychia is the term that describes spoon shaped nails. Spoon shaped nails may be present in patients with long-standing iron deficiency anemia. A CBC should be performed to assess for anemia. The most common symptoms of iron deficiency anemia are weakness, headache, irritability, fatigue, and exercise intolerance.
Question:
A 60 year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused this?
Coronary artery diseaseHepatic cirrhosis CorrectLead toxicityIron deficiency anemia
Explanation:
Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease.
Question:
Impetigo is characterized by:
honey-colored crusts. Correctsilvery scales.marble-like lesions.wheals with pus.
Explanation:
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.
Question:
A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent with this?
Clue cellsHerpes simplexHyphae CorrectLeukocytes
Explanation:
A Wood’s lamp emits ultraviolet light when turned on. If an area fluoresces under Wood’s lamp illumination, a fungal (and sometimes bacterial) infection should be suspected. The test is most effectively performed in a darkened room so the fluorescence can be more easily identified. Deodorant, soap, and make-up may also fluoresce. About one-third of hyphae fluoresce.
Question:
A skin disorder has a hallmark finding of silvery scales. What word below describes this common condition?
Chronic CorrectInfectiousContagiousAcute
Explanation:
“Silvery scales” describes the hallmark finding in psoriasis. This is a chronic condition. It is not infectious, contagious, or acute. There are several variants, but “silvery scales” is the most common form.
Question:
A patient will be taking oral terbinafine for fingernail fungus. The NP knows that:
This will cure her infection 95% of the time. Incorrecta topical antifungal will work just as well when the nail matrix is involved.Terbinafine is a potent inhibitor of the CYP 3A4 enzymes. Correcttoenail fungus resolves faster than fingernail fungus after treatment.
Explanation:
Most oral antifungal agents inhibit the 3A4 enzymes in the cytochrome P450 system. This is why they must be used with extreme caution (or not used) in patients who consume medications that need 3A4 enzymes for metabolism. And, liver enzymes must be monitored in patients who take oral antifungal medications and discontinued if elevations are >2.5 times the upper limits of normal. There is no oral agent that has a 95% cure rate for fingernail fungus (tinea unguium). This can be a difficult infection to clear even if oral antifungal agents are utilized. A topical antifungal agent typically will not clear the infection if the nail matrix is involved. There is anecdotal evidence that menthol ointments or bleach may cause resolution when used topically. Generally, resolution of fingernail fungus occurs more rapidly than toenail fungus because toenails grow at slower rates than fingernails.
Question:
Which of the following areas of the body has the greatest percutaneous absorption? Sole of the footScalp IncorrectForeheadGenitalia Correct
Explanation:
Genitalia have the highest percutaneous absorption across the entire body. This is important because low potency creams will act with greater potency in this area. Always start with low potency creams in the genitalia. The sole of the foot has the lowest percutaneous absorption followed by the scalp, forehead, and genitalia. Therefore, the sole of the foot will require more potent vehicles to enhance absorption.
Question:
A patient who has been in the sun for the past few weeks is very tanned. He has numerous 3-6 mm light colored flat lesions on his trunk. What is the likely etiology?
Tinea corporisTinea unguiumTinea versicolor CorrectHuman papilloma virus
Explanation:
Tinea versicolor is typically visualized during the spring and summer months when a patient has become tanned. 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.
Question:
The nurse practitioner is examining a 3-month old infant who has normal development. She has identified an alopecic area at the occiput. What should be done?
Order a TSHOrder a hydrocortisone creamSuspect child abuseEncourage the caregiver to change the infant’s head position Correct
Explanation:
In a normally developing infant, an alopecic area at the occipital area is generally because the infant has been placed in the supine position during sleeping and waking hours. Prolonged pressure on the occipital area can restrict hair growth. This is normal and will resolve when the infant begins to have better head control and movement; and he begins to have less pressure on the occipital area. Sometimes coarse, dry hair can be indicative of hypothyroidism; not necessarily alopec
Question:
A patient calls your office. He states that he just came in from the woods and discovered a tick on his upper arm. He states that he has removed the tick and the area is slightly red. What should he be advised?
No treatment is needed. CorrectHe should be prescribed doxycycline. IncorrectHe needs a topical scrub to prevent Lyme Disease.He should come to the office for a ceftriaxone injection.
Explanation:
Many factors must be present for a patient to develop Lyme Disease from a tick bite. First, the tick must belong to Ixodes species. The tick must have been attached for at least 48-72 hours before disease can be spread. Time of year, stage of organism's development, and others all affect transmission. There is no need for prophylactic treatment in this case because the tick has not been present long enough, though, many patients will feel antibiotics are necessary.
Question:
An example of a first generation cephalosporin used to treat a skin infection is:
cephalexin. Correctcefuroxime.cefdinir.ceflamore.
Explanation:
Two common first generation cephalosporins used to treat skin and skin structure infections are cephalexin and cefadroxil. These are taken 2-4 times daily and are generally well tolerated. These antibiotics provide coverage against Staphylococcus and Streptococcus, common skin pathogens
Question:
Which of the following skin lesions in the elderly is a premalignant condition? XanthelasmaChalazionHordeolumActinic keratosis Correct
Explanation:
Actinic keratosis is a premalignant condition of the skin and is considered an evolving carcinoma in situ. It is a precursor of squamous cell carcinoma. The lesions are usually multiple in occurrence and sit on an erythematous base. They appear dry, scaly, and flat and are usually secondary to sun damaged skin so can be found on sun exposed areas. The most common sites are the face, ears, lateral forearms, and tops of hands.
Question:
A 74 year-old is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed?
An oral antiviral agent CorrectAn oral antiviral agent plus an oral steroidAn oral antiviral agent plus a topical steroidA topical steroid only
Explanation:
An oral antiviral agent such as acyclovir, famciclovir, 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 benefit. Adverse events to therapy are more commonly reported in patients receiving oral corticosteroids. There is no evidence that corticosteroid therapy decreased the incidence or duration of post-herpetic neuralgia or improved quality of life. Corticosteroids should be limited to use in patients with acute neuritis who have not derived benefit from opioid analgesics.
Question:
A child with a sandpaper textured rash probably has:
rubeola.strept infection. Correctvaricella.roseola. Incorrect
Explanation:
Streptococcal infections can present as a sandpaper textured rash that initially is felt on the trunk. Rubeola, measles, produces a blanching erythematous “brick-red” maculopapular rash that begins on the back of the neck and spreads around the trunk and then extremities. Varicella infection produces the classic crops of eruptions on the trunk that spread to the face. The rash is maculopapular initially and then crusts. Roseola produces a generalized maculopapular rash preceded by 3 days of high fever.
Question:
Patients with atopic dermatitis are likely to exhibit:
Itching. Correctasthma and allergic bronchitis.nasal polyps and asthma.allergic conjunctivitis and wheezing.
Explanation:
Atopic dermatitis is diagnosed on clinical presentation and includes evidence of pruritic skin. It is recurrent and often begins in childhood. For decades the "atopic triad" has been used to refer to patients with atopic
dermatitis, asthma, and allergic rhinitis. This has recently been called in to question. A similar triad, known as Samter’s triad, consists of asthma, aspirin sensitivity, and nasal polyps. Samter’s triad is not the same as the atopic triad.
Question:
The most common place for basal cell carcinoma to be found is the:
scalp.face. Correctanterior shin.upper posterior back.
Explanation:
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% is found on the trunk.
Question:
A key component of the approach to a patient who has atopic dermatitis is hydration. Which agent should be avoided?
Lotions CorrectCreamsThick creamsOintments
Explanation:
In contrast to creams and ointments, lotions have a high water content and a low oil content. These can worsen xerosis (dry skin) due to evaporation of water on the skin. Creams have a lower water content. Ointments have no water and are excellent agents to use on dry skin as well as to prevent dry skin.
Question:
A young child has developed a circumferential lesion on her inner forearm. It is slightly raised, red and is pruritic. It is about 2.5 cm in diameter. This is probably related to:
a genetic disorder.the child’s new cat. Correctjuvenile rheumatoid arthritis.a psoriatic lesion.
Explanation:
This describes ringworm. It is a fungal infection that is common in children. A typical precipitant is a new animal like a cat. Since it appears on the inner forearm, it is likely the child got this from holding the cat. It should be treated with a topical anti-fungal agent
Question:
A patient has used a high potency topical steroid cream for years to treat psoriasis exacerbations when they occur. She presents today and states that this cream “just doesn’t work anymore.” What word describes this?
Rebound effectTachyphylaxis CorrectTolerance IncorrectLichenification
Explanation:
Tachyphylaxis is the word used to describe a gradual and progressively poorer clinical response to a treatment or medication. This is particularly true of topical glucocorticoids, bronchodilators, nitroglycerine, and antihistamines when they are overused. The rebound effect describes a condition where initial clinical improvement occurred, but worsening now has occurred. Lichenification refers to a thickening of the skin. Drug free intervals are important to prevent tachyphylaxis.
Question:
A 28 year-old has thick, demarcated plaques on her elbows. Which features are suggestive of psoriasis?
Scaly lesions on the scalpPruritis around the lesionsA scaly border around the plaquesSilvery scales that are not pruritic Correct
Explanation:
There are many different presentations of psoriasis. Plaque psoriasis, which is described in this question, is
usually found in a symmetrical distribution on the scalp, elbows, knees, and/or back. The size of the lesions ranges from 1-10 cm in diameter. Usually the plaques are asymptomatic, but may be mildly pruritic. Scaly lesions found on the scalp are not specific to psoriasis and could be seborrheic dermatitis. A scaly border around the plaque could describe the lesions associated with pityriasis rosea.
Question:
What finding characterizes shingles?
Pain, burning, and itchingUnilateral dermatomal rash CorrectGrouped vesiclesResolution of rash and crusting
Explanation:
Shingles is herpes zoster. It characteristically affects a single dermatome. Grouped vesicles on an erythematous base can be seen in some patients with shingles, but this is not unique to shingles. In fact, it is typical in many viral infections. Crusting may be seen with shingles, chicken pox, or impetigo. Pain, burning, and itching describes the symptoms that some patients have with shingles, but not all patients report itching with shingles.
Question:
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 dermatitisDyshidrotic dermatitis CorrectHerpes zosterVaricella zoster
Explanation:
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 the case.
Question:
A patient exhibits petechiae on both lower legs but has no other complaints. How should the NP proceed?
Refer to hematologyOrder a CBC CorrectOrder blood culturesStop aspirin and re-assess in one week
Explanation:
The presence of petechiae on the lower legs (or anywhere on the body) should prompt the NP to consider a problem that is platelet related. A CBC should be checked to assess the platelet count and any evidence of anemia from blood loss. If the platelet count is found to be low, referral to hematology should be done.
Blood cultures are of no value in this patient who has no other complaints.
Question:
A 16 year-old male has nodulocystic acne. What might have the greatest positive impact in managing his acne?
Retin-A® plus minocyclineBenzoyl peroxide plus erythromycinIsotretinoin (Accutane®) CorrectOral antibiotics
Explanation:
Nodulocystic acne is the most severe form of acne vulgaris. Nodules and cysts characterize this disease. They can be palpated and usually seen on the skin, although, they actually are under the skin’s surface. They develop when the follicle wall ruptures and leaks pus and cell contents in the dermis. The contaminated material infects adjoining follicles and the nodule develops. Isotretinoin is the only known effective treatment.
Question:
A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive ELISA for Borrelia. The Western blot is positive. How should he be managed?
He should receive doxycycline for Lyme disease. CorrectHe should receive penicillin for Rocky Mountain spotted fever (RMSF).He does not have Lyme disease or RMSF.He needs additional testing to confirm Lyme disease.
Explanation:
The first serologic test for Lyme disease is the ELISA. If this is positive, it should be confirmed. In this case, it was confirmed by a Western blot and it is positive. This patient can be diagnosed with Lyme disease. The appropriate treatment for treatment of erythema migrans is doxycycline, amoxicillin, or cefuroxime for 21 days. All three medications were found to be of equal efficacy.
Question:
A pregnant mother in her first trimester has a 5 year-old who has Fifth Disease. What implication does this have for the mother?
She does not have to worry about transmission to the fetus.She may get a mild case of Fifth disease.There is a risk of fetal death if she becomes infected. CorrectThe mother should have a fetal ultrasound today. Explanation:
Pregnant mother should avoid exposure to patients with known Fifth disease. However, the risk of transmission is very low. She should avoid exposure to aplastic patients who are infected because they are highly contagious. Infection during pregnancy is associated with 10% fetal death. There is no need for an ultrasound today. This pregnant patient does not have evidence of disease. She should be monitored for a rash which could indicate infection.
Question:
A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate:
hyphae. Correctyeasts.rods or cocci.a combination of hyphae and spores.
Explanation:
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.
Question:
A topical treatment for basal cell carcinoma is:
sulfacetamide lotion.5-fluorouracil. Correcttetracycline lotion.trichloroacetic acid. Incorrect
Explanation:
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.
Question:
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. Correctthe lips, oral mucosa, and tongue.tympanic membrane and skin only.
Explanation:
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 is a result of liver disease usually, but 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.
Question:
A patient has been diagnosed with MRSA. She is sulfa allergic. Which medication could be used to treat her?
AugmentinTrimethoprim-sulfamethoxazole (TMPS)CeftriaxoneDoxycycline Correct
Explanation:
MRSA is methicillin resistant Staph aureus. This is very common in the community and is typically treated with sulfa medications like TMPS (Bactrim DS and Septra DS). If the patient is sulfa allergic, this could 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 mentioned and so they should NOT be used to treat it.
Question:
An adolescent has acne. The nurse practitioner prescribed a benzoyl peroxide product for him. What important teaching point should be given to this adolescent regarding the benzoyl peroxide?
Don’t apply this product more than once dailyThis often causes peeling of the skinPhotosensitivity of the skin can occur CorrectHypersensitivity can occur with repeated use
Explanation:
Benzoyl peroxide can produce sensitivity to the sun and so adolescents should be informed of this. This product can be used twice daily. It can cause peeling of the skin, but this is not a frequent occurrence. Hypersensitivity can occur with any topical product and is not specific to benzoyl peroxide. [Show Less]