Module 5 Practice Questions Flashcards
(33 cards)
Why don’t we want to give steroid refills?
Prolonged use can cause systemic affects, secondary dermatitis, epidermal cysts, etc.
What steroids can the APRN prescribe?
Can prescribe potent steroids but will typically give 3-7 (medium to least potent): triamcinolone acetonide, betamethasone valerate, hydrocortisone, desonide, hydrocortisone butyrate.
Your patient is concerned about a spot on their face that has been there for about three months. The lesion is raised in the center and has a pearly border, with a distinct margin. What is your diagnosis?
Basal Cell Carcinoma
An 80-year-old client has an extremely painful rash along her rib cage on her left side. The rash is raised, red, and has clear vesicles. The best management plan is?
A -cyclovir
Valcyclovir 1,000 mg orally three times daily for seven days
Your patient is reporting blisters that have erupted on their lip, body aches, a sore throat, and a headache. This is the first time they have experienced this. The exam reveals, positive cervical lymphadenopathy, a cluster of tiny blisters with red rims and yellow fluid at the corner of her lower lip, and an elevated temperature of 100.8*F, other vital signs are normal. Your most likely diagnosis is:
primary herpes simplex infection
Your patient is being treated for Psoriasis. You know that essential education for this patient includes:
Psoriasis is a chronic disease process and the importance of adherence to prescribed regimens
When considering which dermatological vehicle of medication to prescribe for the treatment of a skin condition, what principles should a clinician follow?
For dry conditions, use moisture preserving vehicles and for wet conditions, use drying vehicles
Tinea is caused by a:
fungus
Which of the following vehicles is the most potent?
ointment
A patient reports a large area of red, raised, shiny skin that encompasses their right calf. The pain is 7 out of 10. They first noticed a small sore on their ankle the day before. Their temperature is 101.1*F. Other vital signs are normal. On examination, there is positive lymphadenopathy noted in their right groin and the right leg is swollen from the knee down. Which interventions should be included in your non-pharmacologic management plan?
rest, compression and elevation
What is true about corticosteroids effect on the skin
corticosteroids can cause thinning and striae of the skin
When considering which antibiotic to prescribe for infections of the skin such as cellulitis, effectiveness against group A beta-hemolytic streptococci, and what other pathogen should guide our choice?
Staphylococcus aureus (group A beta-hemolytic streptococci are the most common cause of cellulitis without purulent drainage, but staphylococcus aureus should be considered if purulent drainage is present or a puncture wound)
A patient has a raised crusted lesion surrounding a center ulcer found on the top of their right ear, which is about the size of a pencil eraser. It has been present for a couple of months. What is the best plan of care?
Advise them about your suspicion of squamous cell carcinoma, and make them an appointment for a biopsy and follow-up before they leave your office.
A medication that can be used initially in the treatment of mild acne :
Topical tretinoin (Retin A)
A patient with Type II diabetes mellitus is seen in the clinic complaining of a burning, pruritic rash under both breasts and in the groin area. They tell the provider that the rash is red and moist and the corn starch they have been using is not helping. Your most likely diagnosis is?
Intertrigo with secondary Candida infection (Intertrigo occurs where there is persistent skin-to-skin contact, erythema, and pruritis suggest secondary fungal infection)
Place the following dermatological vehicles in order of increasing oil content and ability to potentiate the pharmacological agent placed in the vehicle [from least potentiating to most potentiating].
solution, gel, lotion, cream, ointment
What is the difference between a Primary and Secondary outbreak of Oral Herpes Simplex? Include the recommended treatment regimen.
Primary outbreak is when an individual is experiencing their first outbreak. Secondary outbreak the individual has preexisting immunity
Treat with -cyclovir
Why is it important to remember the type of vehicle for medication management with dermatologic conditions?
Because the vehicle helps the delivery of the medication into the deeper regions of the skin. If the wrong vehicle is chosen it can be potent and also affect patient compliance. Vehicles are chosen based upon the size and properties of the skin to be treated
What are the primary Subjective and Objective data that present with Psoriasis?
Subjective: scale-like patches, areas bleed easily, may have “raindrop” plaques (some can be smaller than 1cm), and the patches are frequently noted on the elbows, knees, scalp, genitals, and intergluteal folds.
Objective: maculopapular lesions that are erythematous and well-circumscribed/demarcated and are covered in silvery white scales (often found in the areas noted in subjective…always look where they report having patches); may have pitting on the nails
When and why do you need to refer a patient with Rosacea?
We would want to refer the patient with Rosacea if their symptoms develop into ocular rosacea and the patient experiences light sensitivity, blurred vision, or foreign body sensation of the eye. This might warrant referral to an opthalmologist. The patient may need to see a mental health provider for body image disturbances or a dermatologist if symptoms do not resolve with treatment.
If you have a patient who has acne vulgaris and they have a history of a blood clot, what would be your recommended management?
Start with nonpharmacologic by having the patient use mild cleansers, if they’re not already, for their skin. Have patients use water-based products to not dry out their skin. Refer the patient to a dermatologist if the patient has recalcitrant or severe nodulocystic acne and if needed, a mental health professional related to depression and self-esteem. As a provider topical therapy, considered to be the first line, may not be the way to go since one of the side effects is erythema. In this case, Oral antibiotics would be an option instead of topical. Ok to use spirinolactone
What is the most common Subjective and Objective data of a patient who presents with concerns for skin cancer?
melanoma has the most pigment changes, can have several colors and irregularity to it
BCC- the most common- pearly, shiny, normal skin color (or slightly pigmented)
SCC- scaly and scabby, bleeds easily, doesn’t heal, volcano shape- does this mean it grows and sits above the skin like a wart?!
actinic keratosis- rough scaly patch on skin, persistent, reddened
What is the difference between Basal Cell Carcinoma and Squamous Cell Carcinoma?
Basal cell carcinoma: commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels.
Squamous cell carcinoma: commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration. “Sore that will not heal”
Your patient comes to you and reports that they have chest pain and lately feel anxious, also some shortness of breath. They have acne vulgaris and have been on drospirenone. Do you need to do any diagnostics? What is your plan of care?
Because drospirenone increases the risk of blood clots, you would want the patient to be checked out for a pulmonary embolus with these symptoms. This goes beyond what can be investigated in clinic, so you can have someone call 911 and get a set of vitals and pulse ox while awaiting the ambulance. They’d need increased monitoring, blood work, and imaging at the nearest hospital.
Of course, you can start with basic vital signs in the office, and throw a pulse ox on just so that you can trend their O2 SATs until the EMS gets there.
