Mod 3 ch 35-51 Flashcards
a patient is seen in the clinic for patches of hair loss. The provider notes several well-dermarcated patches on the scalp eyebrows without areas of inflammation and several hairs within the patch with thinner shafts near the scalp. Based on findings which type of alopecia is most likely?
a. alopecia areata
b. anagen effluvium
c. Cicatricial alopecia
d. telogen effluvium
a. alopecia areata (description is consistent with type of alopecia)
Types of hair loss:
- Telogen caused by hairs entering Telogen phase of hair cylce (mature shedding, last phase) too soon. results in sudden hair loss. multiple factors /conditions may cause this: Anemia, endocrine disorders, malnutrition, childbirth may persist for several months.
* presents as diffuse hair loss, non inflam
Anagen efluivium- some kind of agent causing rapid diffuse hair loss like Chem/radiation will spontaneously resolve once agent is stopped.
presents as diffuse hair loss, non-inflam
Cicatrical is inflammatory hair loss, results in scarring and atrophy.
A patient is diagnosed with alopecia is noted to have scaling on the affected areas of the scalp. Which confirmatory test will the provider order?
a. Examination of scalp scraping with potassium hydroxide (KOH)
b. grasping and pulling on a few dozen hairs
c. serum iron studies and CBC
d. Veneral Disease Research lLboratory
a. Examination of scalp scraping with potassium hydroxide (KOH)
Scaling on scalp is consistent with Tinea Capititis (fungal) which case KOH will show presence of hyphea to confirm diagnosis
Hair pulling used to identity anagen or telogen hairs by appearance of what stage is hair cycle they are
Serum Iron and CBC studies are used do help identify
possible cause of hair loss (tologen efluvium)
A female is dianosed with androgenetic alopecia. Which medication will the primary health care provider prescribe?
a. Anthralin
b. Cyclosporin
c. Finasteride
d. Minoxidil (Rogain)
d. Minoxidil (Rogain)
Androgenetic alopecia is hereditary hair loss r/t to the scalp sensitive to androgens
Finesteride an Minoxidil are approved for androgenetic alopecia however finesteride is not approved for pregnancy.
A primary care provider is performing a Tzanck test to evaluate possible herpes simplex lesions. To attain accurate results, the provider will perform what intervention?
a. Blanch the lesions while examining them with a magnifying glass
b. Gently scape the lesions with a scalpel onto a slide
c. Perform a gram stain of exudate from the lesions
d. Remove the top of the vesicles and obtain fluid from the lesions
d. Remove the top of the vesicles and obtain fluid from the lesions
Blanching of blue to red lesions under a microscope helps to evaluate whether blood is in the capillaries of the lesions.
scaping lesions onto a slide is done to evaluate the presence of hyphae and spores common with candidiasis or fungal infections
gram staining is performed to distinguish gram[positive from gram-negative organism in suspected bacterial infections
When examinign a patient’s skin, a practitioner uses dermoscopy for what purpose. Select all that apply
a. Accentuating changes in color of pathologic lesions
b. assessing changes in pigmentation throughout various lesions
c. Determining whether lesions borders are regular or irregular
d. differentiating fluid masses from cystic masses in the epidermis
e. Visualizing skin fissures, hair follicles and pores in lesions
b. assessing changes in pigmentation throughout various lesions
c. Determining whether lesions borders are regular or irregular
e. Visualizing skin fissures, hair follicles and pores in lesions
Woods light (black light) is used to fluoresce lesions to accentuate changes in color to look for skin diseases
Direct light is used for differentiating fluid mases from cystic masses
A patient has actinic keratosis and the provider elects ot use cryosurgery to remove the lesions. How will the provider administer this procedure?
a. applying on e of two freeze thaw cycles to each lesion
b. applying two or more freeze thaw cycles to each lesions
c. applying until the freeze spreads laterally 1mm from lesion edges.
d. applying until the freeze spreads laterally 4mm from lesion edges.
a. applying on e of two freeze thaw cycles to each lesion
Actinic Keratosis skin condition caused by sun damage, causes rough, scaly, bumpy spots on skin
cyrosurgery is freeze therapy used to remove benign recognizable skin conditions
two or more freeze thaws are needed for thicker. seborrheic lesions.
A provider is preparing to administer electrocautery to a patient who has several seborrheic keratoses. The patient tells the provider that he has a pacemaker, Which action is correct?
a. administer the electrocautery per the usual protocol
b. apply electrocautery in short burst at low voltage
c. refer the patient to a dermatologist for removal
d. suggest another method for removal of the lesions
b. apply electrocautery in short burst at low voltage
Patient’s with pacemakers may receive this therapy because the patient is not involved the electrical loop. It is only delivered to the tissue.
This procedure is usually done over in non conductive tissue like bone, cartilage or nails
it causes protein denaturation and coagulation uses low voltage and heat transfer to the tissue
Which type of office surgical procedure warrants sterile technique?
a. curettage
b. punch biopsy
c. scissor excision
d. shave biopsy
b. punch biopsy
others you can do with alcohol and clean technique
When recommending an OTC topical medication to treat a dermatologic condition, which instruction to the patient is important to enhance absorption of the drug.
a. apply a thick layer of medication over the affected are
b. a solution spray preparation will be more effective on hairy areas
c. put cool compresses over the affected area after application
d. use lotion or cream instead of an ointment preparation
b. a solution spray preparation will be more effective on hairy areas
Hairy areas of difficult to penetrate, so in these areas a solution, foam, spray or gel may work better
**TCS work better with moisturizer and emollient
applying a thick layer does not increase skin penetration or effectiveness
warm or inflamed skin absorbs medication more readily
lotions or creams are not as readily absorbed as ointments
A provider is prescribing a topical dermatologic medication for a patient who has open lesions on a hairy area of the body. which vehicle type will the prover chose wen prescribing tis mediation
a. cream
b. gel
c. ointment
d. powder
b. gel
gels work well on hairy areas
creams and ointments do not
powders should not be used over open wounds the decrease friction
An adult patient has been diagnosed with atopic dermatitis (eczema) and seborrheic dermatitis lesions on the forehead and along the scalp line. Which is correct when prescribing a corticosteroid medication to teat this condition?
a. initiate treatment with 0.1% triamcinolone acetonide
b. monitor the patient closely for systemic adverse effects during use.
c. place on occlusive dressing over the medication after application
d. prescribe 0.05% fluocinonide to apply liberally
a. initiate treatment with 0.1% triamcinolone acetonide
this is appropriate because it is a class 4 and may be used on the face systemic effects with TCS are rare and occlusive dressing increase absorption. Fluocinonide is a class 2 and should not be used on the face
classed 1-4 should not be used on the face
Seborrheic dermatitis dandruff, inflamed scaly patches or cradle cap caused by antifungal
During a total body skin examination for skin cancer, the provider notes a raised, shiny slightly pigmented lesion on the patient’s nose. What will the provider do?
a. consult with a dermatologist about possible melanoma
b. reassure the patient that this is a benign lesion
c. refer the patient for possible electrodessication and curettage
d. tell the patient this is likely a squamous cell carcinoma
c. refer the patient for possible electrodessication and curettage
This is characteristic of a BCC, which is treated with electrodessication (scrapping and burning off skin growths) the direct application to the skin lesion uses damp high voltage and causes superficial tissue damage and cell death
melanomas are usually asymmetrical lesions with irregular boarder, variable in color and >6mm (ABCDs)
SCC are roughened, scaling and bleeds easily and treated by total excision
What is the initial approach when obtaining a biopsy of a potential malignant melanoma
a. excisional biopsy
b. punch biopsy
c. shave biopsy
d. wide excision
a. excisional biopsy
excisional biopsy (whole lesion is removed) if diagnosed with MM, a wide excision should follow which is removal of some of the surrounding tissue
punch and shave biopsy are for NMSC lesions
A patient has acne and the provider notes lesions on half of the face, some nodules and two scared areas. Which treatment will be prescribed?
a. Oral clindamycin for 6-8 weeks
b. oral isotretinoin
c. topical benzoyl peroxide and clindamycin
d. topical erythromycin
c. topical benzoyl peroxide and clindamycin
topical treatment is 1st line
Based on symptoms this patient has moderate acne
moderate acne- nodules and scars on 1/2 of face
severe- involves acne 3/4 face with nodules and scars
organism associated with acne is P. Anes
oral atb are reserved for severe acne
isotretinoin is used for severe nodulocystic acne that is not receptive to other treatment is a tertogenic.
A provider is considering an oral contraceptive medication to treat acne in an adolescents female. Which is an important consideration when prescribing this drug.
a. a progesterone-only contraceptives is most beneficial for treating acne
b. combined oral contraceptives are effective for non-inflammatory acne only
c. oral contraceptives are effective because of their androgen enhancing effects
d. Yas, Ortho Tri-Cyclen, and Estrostep, are approved for acne treatment.
d. Yas, Ortho Tri-Cyclen, and Estrostep, are approved for acne treatment. (COCs)
progesterone only BC may worsen acne
Combined oral contraceptives are effective in reducing inflammatory and non-inflammatory acne (Best option)
**they are effective because they supress androgens which produce sebum (androgens) ** BC are antiandrogens!
topical antibiotics are not recommended to monotherapy
A female patient is diagnosed with hidradenitis suppurative and has multiple areas of swelling, pain and erythema., along with several abscesses in the right femoral area. When counseling the patient about this disorder the practitioner will include which information?
a. antibiotic therapy is effective in cleaning up the lesions
b. it is often progressive with relapses and permanent scarring
c. the condition is precipitated by depilatories and deodorants
d. the lesions are infective, and the disease may be transmitted to others.
b. it is often progressive with relapses and permanent scarring
hidradenitis Suppurativa is a disease of the apocrine gland characterized by inflamed papules and abscess in axillae and inguinal areas from unknown cause common in early 20s. something causes apocrine glands not to drain properly and pressure builds up. bacteria can cause them to burst often progression and relapsing can occur
treatment antibiotics ( 6-8 weeks) is not the only treatment, may be drained or NSAIDS may be used
When counseling a patient with rosacea about management of this condition, the provider may recommend? select all that apply a. applying a topical steroid b. avoiding makeup c. avoiding oil-based products d. eliminating spicy foods e exposing the skin to sun f. using topical antibiotics
c. avoiding oil-based products
d. eliminating spicy foods
f. using topical antibiotics
Rosacea-facial flushing/erythema, with inflamed postules resembles acne they do not have comedones (black heads) may cause eyewatery or ocular problems
there are certain triggers for it.
treatment same as acne topical or oral atb topical steroids make it worse! may take months to work
Which medications may be used as part of the treatment for a patient with hidradenitis suppurativa? Select all that apply
a. chemo
b. erythromycin
c. infiximab
d. isotretinoin
e. prednisone
b. erythromycin
c. infiximab
d. isotretinoin
e. prednisone
and NSAIDS and Birth control.
this is the disease of the apocrine gland it is not malignant
A young adult has been bitten by a dog resulting in multiple puncture wounds near the thumb of one hand but can move all fingers and the bleeding has stopped. What understanding regarding dog bites should direct the care of this patient?
a. infection is likely outcome for a dog bite
b. dog bites generally result in serious injury.
c. neurovascular and destructive soft tissue injuries can occur from such a bite
d. oral antibiotics are needed to address the increased risk for the development of osteomyelitis
c. neurovascular and destructive soft tissue injuries can occur from such a bite
dog bites have the lowest incidence of infection risk.
A patient has sustained a human bite on the hand during a fist fight. Which is especially concerning with this type of bite injury?
a. possible exposure to rabies virus
b. Potential septic arthritis or osteoarthritis
c. sepsis from Capnocytophga canimorus
d. transmission of human immunodeficiency virus
b. Potential septic arthritis or osteoarthritis
Clenched fist injury (CFI)
humans do not transmit rabies
Which type of bite is generally closed by delayed primary closure? select all that apply a. bites to the face b. bites to the hand c. deep puncture wounds d. dog bites on an arm e wounds 6 hours old or older
b. bites to the hand
c. deep puncture wounds
e wounds 6 hours old or older
Cat and human bites are high risk for infection must keep open
dog bites so do not generally require delated or secondary closure
When assessing with a skin biopsy of a patient suspected of having bullous pemphigoid (BP) lesions, what will the practitioner do?
a. avoid contact with the infected lesion
b. elicit a positive Nikolsky
c. Perform direct immunofluorescence microscopy
d. prevent spread of the lesions to other areas of the skin
c. Perform direct immunofluorescence microscopy
Direct immunofluorescence microscopy is the gold standard for diagnosis of BP. in order to determine the presence of IgG antibodies
BP is an autoimmune disorder characterize by large, super dermal blisters that occur on normal erythematous skin. Very pruritic. IgG antibodies attack the structure of the epi and dermis
more common in older adults
The lesions are not infected. The Nikolsky sign will be negative in patients with BP. The lesions do not spread by this manner
An older adult patient diagnosed with bullouw pemphigoid )BP). Which comorbid condition is of concern for this patient?
a. Osteoporosis
b. Pruritis
c. depression
d. weight gain
c. depression
A patient is newly diagnosed with bullous pemphigoid and has moderate to severe itching. the provider orders a topical corticosteroid and will discuss which potential complication with this patient?
a. BMT
b. Developing systemic lesions
c. secondary infection
d. spread of disease to others
c. secondary infection
goal of TCS is to decrease inflammation in BP control puritis and suppress the immune system.
