DERMATOLOGY Flashcards
(41 cards)
A 45-year-old woman presents with thickened, discolored toenails. She mentions the condition has persisted for several years, and she has tried various over-the-counter treatments without improvement. Her liver function tests are normal. What is the most appropriate initial treatment plan?
Answer Choices:
A. Prescribe topical ciclopirox
B. Refer to dermatology for nail debridement
C. Initiate oral terbinafine
D. Continue with over-the-counter topical treatment
C. Initiate oral terbinafine - Over-the-counter treatments have not been effective, and given the chronic nature of the condition and nail involvement, oral antifungals like terbinafine, with monitoring of liver function due to potential hepatotoxicity, is a more appropriate initial treatment choice. Topical medications often have low efficacy for extensive onychomycosis. Referral for nail debridement or dermatology may follow if needed.
A patient reports recurrent painful genital lesions and was previously diagnosed with HSV-2. Which testing method could determine if the patient is having an active outbreak?
Answer Choices:
A. Viral culture from a lesion
B. HSV antibody titer
C. Complete blood count (CBC)
D. Rapid plasma reagin (RPR) test
A. Viral culture from a lesion - A viral culture of a lesion can confirm if the active virus is present, indicating an outbreak. HSV antibody titer indicates past exposure and seroconversion but does not specify current activity. A CBC and RPR are not relevant for confirming an active HSV infection.
A 10-year-old child is diagnosed with tinea capitis. Which prevention advice is most appropriate to prevent the spread of the infection to family members?
Answer Choices:
A. Share combs and hairbrushes only with siblings
B. Use each family member’s towel and wash them regularly
C. Maintain wet and tightly braided hair to protect it
D. Utilize shared headgear for protection
B. Use each family member’s towel and wash them regularly - Preventing tinea capitis spread involves avoiding sharing personal items such as towels, combs, and headgear. Towels should be individual and washed regularly to minimize fungal spread. Tightly braiding hair when wet can increase moisture, promoting fungal growth rather than mitigating it.
A 30-year-old man presents with multiple episodes of insect bites with localized reactions despite wearing protective clothing. Which is most likely to have predisposed him to his heightened sensitivity upon reexposure?
Answer Choices:
A. Family history of allergic reactions
B. Use of topical antihistamines
C. Previous exposure to similar insect venoms
D. Systemic bacterial infection
C. Previous exposure to similar insect venoms - Sensitization usually occurs after previous exposure to the insect venoms, predisposing individuals to more significant reactions, such as anaphylaxis, upon reexposure. Family history can play a role, but the direct impact is from previous exposure buildups.
For a patient experiencing their first occurrence of oral herpes (HSV-1), what would be appropriate advice regarding symptom management?
Rational Question:
What advice regarding over-the-counter topical application should be provided for managing symptoms?
Advice should include using over-the-counter topical anesthetics and soothing creams to manage local pain. Patients should also maintain adequate hydration and avoid trigger foods that might exacerbate symptoms. These topical applications help manage pain associated with lesions and promote healing comfort. Warm compresses can soothe, but if patients have applied antimicrobials, educate them about their limited effects on viral replication and overall symptom management.
A 35-year-old man presents with complaints of macerated, peeling skin between his toes accompanied by a strong odor. Based on your understanding of tinea pedis, what is an effective initial management step you should recommend?
Answer Choices:
A. Use an occlusive dressing between toes
B. Initiate broad-spectrum antibiotics
C. Apply drying foot powders such as miconazole
D. Recommend soaking feet in warm water twice daily
C. Apply drying foot powders such as miconazole - Tinea pedis is a fungal condition where moisture control is key. Applying an antifungal drying powder helps reduce moisture and control the fungal infection. Occlusive dressings can trap moisture, antibiotics are not effective against fungal infections, and soaking can exacerbate maceration if not carefully dried afterward.
During a routine examination, a 40-year-old woman presents with well-demarcated, erythematous plaques covered with silvery scales on her elbows and scalp. Which characteristic of psoriasis should be further explored during your assessment?
Answer Choices:
A. Family history of similar skin conditions
B. History of allergies to topical treatments
C. Previous episodes of viral infections
D. Recent weight changes
A. Family history of similar skin conditions - Psoriasis has a strong genetic component, so understanding family history can provide critical information regarding her predisposition to psoriasis. While treatment reactions and infections might be important, genetic predisposition is a pivotal factor in diagnosis.
A 25-year-old patient diagnosed with psoriasis reports using topical corticosteroids with limited success. As an FNP, you consider a referral. What is the most appropriate action to take next?
Answer Choices:
A. Increase the potency of the topical corticosteroids
B. Switch to over-the-counter remedies
C. Refer the patient to a dermatologist for further evaluation
D. Encourage the patient to try alternative medicine
C. Refer the patient to a dermatologist for further evaluation - If the patient is not responding adequately to topical corticosteroids, which are standard treatment, a dermatologist can provide more specialized options, including systemic treatments or biologics.
Which question should you prioritize asking a patient with a new diagnosis of psoriasis to identify potential exacerbating environmental factors?
Answer Choices:
A. Have you experienced any recent infections or illnesses?
B. Have you noticed any changes in your diet recently?
C. Are there any new stressors in your life?
D. Do you exercise regularly?
C. Are there any new stressors in your life? - Stress is a well-known trigger for psoriasis exacerbations. While dietary and exercise habits are important to overall health, identifying stressors can directly relate to psoriasis flare-ups.
A patient with extensive tinea pedis that has not responded to topical treatments is being considered for systemic therapy. What condition should be ruled out before prescribing oral antifungals like terbinafine?
Answer Choices:
A. Diabetes mellitus
B. Liver dysfunction
C. Renal insufficiency
D. Cardiovascular disease
B. Liver dysfunction - Oral antifungals, such as terbinafine, can affect liver function. It is crucial to assess liver health and function prior to initiating systemic antifungal therapy due to the potential for hepatotoxicity. Monitoring liver enzymes and function is an essential ongoing consideration for patients on these medications.
A 28-year-old female presents with a swollen, erythematous area around the base of her index fingernail after a manicure a few days ago. There is pain and mild purulent discharge. Based on the description, what is the most likely initial diagnosis?
Answer Choices:
A. Chronic paronychia
B. Acute paronychia
C. Cellulitis
D. Onychomycosis
B. Acute paronychia - The symptoms presented, such as swelling, erythema, and purulent discharge following a manicure, are indicative of an acute paronychia, which commonly results from trauma to the cuticle or nail fold.
A patient with a 3-day history of a painful and erythematous swollen bump on the back of the neck, commonly referred to as a “spider bite,” is clinically suspected to have CA-MRSA. Which step is essential to confirm the diagnosis?
Answer Choices:
A. Initiating antibiotic treatment
B. Physical examination
C. Obtaining a culture of the lesion
D. Assessing for family history
C. Obtaining a culture of the lesion - Confirmatory diagnosis of CA-MRSA is achieved by culturing the lesion, which will allow for antibiotic sensitivity testing, ensuring targeted treatment.
A 45-year-old who frequently immerses her hands in water presents with a swollen, painful nail fold lasting for over two months. What is the appropriate initial treatment?
Answer Choices:
A. Warm water soaks and mupirocin
B. Oral antibiotics such as dicloxacillin
C. Topical steroid and antifungal
D. Incision and drainage
C. Topical steroid and antifungal - Chronic paronychia results from a combination of fungal infection and inflammation. Therefore, a topical steroid to manage inflammation and an antifungal to treat Candida albicans are appropriate initial treatments, especially considering the chronicity and occupation-related etiology.
A teenager presents with a painful, fluctuant abscess in the forearm area. Upon further assessment, CA-MRSA is suspected. What is the first-line treatment option to manage this type of abscess?
Answer Choices:
A. Oral antibiotics immediately
B. Incision and drainage
C. Topical antifungals
D. Applying warm compresses
B. Incision and drainage - For a fluctuant abscess suspected to be caused by CA-MRSA, the first step is an incision and drainage (I&D) of the abscess, as it releases purulent material and is often curative without the need for systemic antibiotics unless there are signs of a spreading infection.
A 32-year-old chef comes to the clinic with a chronic nail infection characterized by lateral nail fold excoriation due to frequent hand washing. What critical step should be included in the management plan?
Answer Choices:
A. Encourage increased handwashing to prevent infection
B. Discontinue all hand submersions immediately
C. Use a topical antifungal and recommend using protective gloves
D. Start oral antibiotics for bacterial infections
C. Use a topical antifungal and recommend using protective gloves - Given the chronic nature related to frequent hand submersion in water, a topical antifungal will address the Candida component, while protective gloves will reduce exposure to moisture and potential irritants, alleviating symptoms and preventing recurrence.
A 10-year-old boy comes to the clinic with a swollen hand after being bitten by his pet cat. It occurred 18 hours ago, and there’s increased warmth, redness, and pain at the site. What would be the most appropriate initial management?
Answer Choices:
A. Observe the wound for another 24 hours
B. Topical antibiotic ointment
C. Oral antibiotics such as Amoxicillin/clavulanate
D. Immediate incision and drainage
C. Oral antibiotics such as Amoxicillin/clavulanate - Cat bites have a high infection rate due to puncture wounds. Early administration of antibiotics such as Amoxicillin/clavulanate is essential to prevent further infection and complications.
A patient arrives in the ER after experiencing anaphylaxis from a bee sting. Which immediate treatment should an FNP initiate?
Answer Choices:
A. Administer diphenhydramine
B. Give oral corticosteroids
C. Apply ice to the sting site
D. Administer intramuscular epinephrine and provide oxygen
D. Administer intramuscular epinephrine and provide oxygen - In cases of anaphylaxis, the priority is to swiftly administer epinephrine and support airway, breathing, and circulation with oxygen, as this is the only intervention that can rapidly halt the anaphylactic process.
A recent snake bite victim arrives at the clinic. Initial symptoms include local swelling and pain without systemic involvement. Which intervention is critical in the management plan?
Answer Choices:
A. Apply a tourniquet above the bite
B. Administer antivenom immediately
C. Elevate the affected limb
D. Wound irrigation with soap and water
B. Administer antivenom immediately - Prompt administration of antivenom is essential for poisonous snake bites to neutralize the venom and prevent systemic effects. Tourniquets can worsen the situation, and proper protocol involves immobilization and transport to medical care for antivenom therapy.
A 32-year-old male presents with a painful, blistering rash on his arm. He recently returned from a trip and recalls an insect bite a few days ago. Based on this and potential vesication, what might the initial management focus on?
Answer Choices:
A. Antibiotics to treat infection
B. Wound debridement
C. Stabilization and cooling, including topical corticosteroids
D. Antihistamines and oral hydration
C. Stabilization and cooling, including topical corticosteroids - Vesicating toxins produce blisters, so the management focuses on calming inflammation and stabilizing the sera, often using topical corticosteroids to reduce further tissue damage. Infection control via secondary antibacterial measures is taken if necessary.
A patient reports a painful hand after being bitten during a fight. Should the bite be considered high risk for certain pathogens, and what management should be pursued?
Answer Choices:
A. Focus on tetanus prophylaxis only
B. Consider the risk of Hepatitis B, C, and HIV
C. Provide rabies prophylaxis
D. Apply local wound cleaning and observation
B. Consider the risk of Hepatitis B, C, and HIV - Human bites, especially with bleeding, are high risk for blood-borne pathogens like Hepatitis B, C, and HIV. Prophylaxis and testing aspects are crucial in the management due to the potential for transmission.
A patient presents with thick, hyperkeratotic lesions on the palms and asks for the most effective topical medication option. What formulation should be recommended?
Answer Choices:
A. Foam
B. Cream
C. Lotion
D. Ointment
D. Ointment - Ointments are the preferred vehicle for smooth, nonhairy skin and thick, hyperkeratotic lesions due to their occlusive nature, which enhances drug penetration and effectiveness.
A middle-aged woman needs a topical solution for a psoriasis flare in her scalp, which is a hairy area. Which formulation is most appropriate?
Answer Choices:
A. Cream
B. Lotion
C. Foam
D. Ointment
C. Foam - Foam is the preferred vehicle for applications on hairy areas like the scalp because it spreads easily and is less greasy than ointments, enhancing patient adherence.
An FNP student is speaking to a patient about the use of a topical solution for a moist, macerated area between skin folds. Which formulation should be avoided due to its properties?
Answer Choices:
A. Cream
B. Solution
C. Gel
D. Ointment
D. Ointment - Ointments have an occlusive nature not typically preferred for moist, macerated areas, as they can exacerbate the moisture and hinder lesion healing recovery.
A patient has been prescribed a topical therapy for an infected eczematous area on the forearm. Which formulation should be considered optimal for treating this site?
Answer Choices:
A. Gel
B. Ointment
C. Foam
D. Solution
D. Solution - Solutions are preferred for treating infected areas because they can dry up exudates and do not provide an environment that promotes further moisture, compared to ointments.
