skin Flashcards
(67 cards)
1
Q
Which of the following is a super-high potency (group 1) topical steroid?
A.Halcinonide cream
B.Mometasone furoate
C.Fluocinolone acetonide
D.Halobetasol propionate
A
Answer: D. Halobetasol propionate
Halobetasol propionate is a super-high potency (class 1) topical steroid. Halcinonide is high potency (class 2), mometasone furoate is medium potency (class 4), and fluocinolone acetonide is low potency (class 6).
2
Q
A patient presents with a circular rash on their arm and reports recent outdoor activities in an area known for ticks. What diagnostic test should be performed?
A.Western blot test
B.Immunofluorescence assay (IFA)
C.Enzyme-linked immunosorbent assay (ELISA)
D.None; no testing required
A
Answer: B. Immunofluorescence assay (IFA)
3
Q
A patient presents to the clinic with severe pain in the right thigh that started 48 hours ago. The area is erythematous, swollen, and warm to touch and has a purplish hue. The patient reports a history of intravenous drug use and a fever of 102°F at home. Despite these symptoms, the patient is hemodynamically stable and alert. What is the most likely diagnosis?
A.Deep vein thrombosis
B.Cellulitis
C.Necrotizing fasciitis
D.Osteomyelitis
A
Answer: C. Necrotizing fasciitis
Given the patient’s history of intravenous drug use as well as the severe pain, fever, and the rapid progression of erythema with a purplish hue, the clinical presentation is most concerning for necrotizing fasciitis. This is a rapidly progressive and potentially life-threatening bacterial skin infection that requires immediate surgical intervention
4
Q
A patient presents with a 2-day history of increasing pain, warmth, redness, and swelling in their lower leg. The patient also reports feeling feverish and generally unwell. The affected skin is tender to touch, and there is no visible pus or abscess formation. What would be the most appropriate next step in diagnosing this patient’s suspected condition?
A.Order an x-ray of the lower leg
B.Perform a punch biopsy of the affected skin
C.Order a complete blood count with differential
D.Recommend an MRI of the lower leg
A
CBC to rule out infection
5
Q
Which of the following methods is preferred for confirming the diagnosis of varicella in a pediatric patient?
A.Polymerase chain reaction (PCR) testing
B.Enzyme immunoassay (EIA)
C.Skin biopsy of the vesicular lesion
D.Bacterial culture
A
PCR
6
Q
older adult where do you check skin turgor
A
just below the clavicle
7
Q
macule is
A
< 1 cm, flat
7
Q
A
8
Q
A
9
Q
Papule
A
elevated
10
Q
A
11
Q
to check for fungal infection do what
A
scrpe and do KOH solution
12
Q
A
13
Q
Psoriasis is aggravated by
A
stress
14
Q
skin conditions that are associated with arthritis is
A
psoriasis
15
Q
what medication can aggravate psoriasis
A
Beta blocker
16
Q
podophyllin pt should wipe off in
A
4-6 hours
17
Q
what is the oral med recommended for rosacia
A
tetracycline
18
Q
what is effectecive for nueripathic pain
A
amitriptyline
19
Q
Bowens is a
A
squamous cell carcinoma does not invade the dermits due curettage and electrodiscetion
20
Q
acanthas nigricans is associated with
A
obesity DM and colon cancer
21
Q
lava migrans is
A
infection of eggs or parasites
22
Q
condylma lata has
A
whitish looking papules in the vulva region
23
Q
Tinea Manuum is
A
fungal infection of the hand assoc with Tinea pedis
24
aprocine sweat gland located in
axillary and anogenital areas
25
eccrine is located in
palms, hands, soles of feet
26
Guttate psoriasis is often proceded by
strep throat
27
papule is
less than 1 cm
28
first-line treatment for persistent folliculitis when methicillin-resistant Staphylococcus aureus (MRSA) is not suspected.
cephalexin
29
Treatment of choice for erysipelas is
Cephalexin (keflex)
30
Cipro is not recommeded against what
Streptococcus pneumoniae infection (C). Streptococcus pneumoniae is a type of bacteria that commonly causes community-acquired pneumonia. Ciprofloxacin is a fluoroquinolone medication that is less active against gram-positive pathogens like Streptococcus pneumoniae. Respiratory fluoroquinolones that effectively treat Streptococcus pneumoniae infection include levofloxacin, gemifloxacin, and moxifloxacin.
31
typically occurs due to repeated scratching or rubbing of a particular area. This is commonly associated with atopic dermatitis due to the itch-scratch-itch cycle that occurs. Treatment involves alleviating the root cause, in this case, the atopic dermatitis.
Lichen simplex chronicus (
32
A 45-year-old woman returns to the clinic after being diagnosed with folliculitis. Topical mupirocin was ordered 10 days ago at her last visit. On examination today, the nurse practitioner notes no improvement in her condition and methicillin-resistant Staphylococcus aureus is not suspected nor prevalent in the community. Which of the following treatments would be most appropriate for the nurse practitioner to prescribe?
cephalexin (keflex)
33
s a benign skin condition that is commonly referred to as goose bump skin or chicken skin due to its rough nature.
Keratosis pilaris
34
A 52-year-old patient presents to the office for evaluation of a new facial rash with a burning sensation. Physical exam reveals erythema, pustules, and telangiectasias on her nose and bilateral cheeks. She reports no oral cavity swelling. Which of the following is the most likely diagnosis?
Rosacea
35
A 12-month-old patient is brought to the pediatric clinic with a history of high fever for the past 3 days that abruptly resolved. The child's parent now reports the appearance of a rash on the child's trunk and extremities. Which of the following accurately describes the diagnostic criteria for the suspected condition?
A.Diagnosis is primarily based on the presence of a characteristic rash following a high fever.
B.Laboratory testing for viral identification is required to confirm the diagnosis.
C.Diagnosis is based on the presence of white or grayish-white spots on the buccal mucosa.
D.Throat culture is performed to confirm the diagnosis.
Answer: A. Diagnosis is primarily based on the presence of a characteristic rash following a high fever.
The nurse practitioner suspects roseola infantum. Diagnosis is primarily based on the presence of a characteristic rash following a high fever. Roseola infantum, also known as sixth disease or exanthem subitum, is a clinical diagnosis made based on the characteristic clinical presentation and history of fever preceding the rash. The fever is typically high and lasts for 3 to 5 days, followed by the appearance of a rash once the fever subsides. The rash is pink or rose-colored and maculopapular in nature, and it often starts on the trunk before spreading to the extremities. The absence of significant symptoms other than fever and rash helps differentiate roseola infantum from other childhood viral exanthems. Laboratory testing for viral identification is not routinely required to confirm the diagnosis of roseola infantum. The diagnosis is primarily based on the characteristic clinical presentation and history. Koplik spots are small, white or grayish-white spots surrounded by a reddish halo and are considered pathognomonic for measles. A throat culture may be performed in suspected cases of streptococcal pharyngitis (strep throat), but it is not specific to roseola infantum.
36
Which of the following is an absolute contraindication to wound closure?
A.Deep stab wounds
B.Wounds caused by clean, sharp objects
C.Wounds older than 24 hours that were insufficiently cleansed
D.Wounds with presence of cellulitis or abscess
Answer: D. Wounds with presence of cellulitis or abscess
An absolute contraindication to wound closure is the presence of cellulitis or abscess (erythema, warmth, swelling, and pain with or without pus drainage). Primary closure is often seen for wounds caused by clean, sharp objects that close up to 12 to 18 hours from the time of injury. Secondary closure is indicated for deep stab or puncture wounds, contaminated wounds, abscess cavities, wound presentation after a significant delay, and non-cosmetic animal bites. Delayed primary closure would be considered for uncomplicated wounds that present after the safe period for primary closure (e.g., wounds older than 24 hours that were insufficiently cleansed).
37
An adult patient presents with moderate to severe plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of 20. The patient is otherwise healthy, without any history of infections, malignancies, or cardiovascular diseases. The patient expresses dissatisfaction with topical therapies, stating that they are inconvenient and have not yielded sufficient results. Which of the following is the best approach?
A.Initiate biologic therapy after performing tuberculosis screening and other necessary baseline tests
B.Initiate methotrexate therapy after performing a liver function test
C.Advise continuation of topical therapy due to its greater safety
D.Start the patient on cyclosporine after performing a renal function test
Answer: B. Initiate methotrexate therapy after performing a liver function test
Psoriasis is a chronic disease that often requires systemic therapy in moderate to severe cases, especially when topical treatments are ineffective or impractical. Methotrexate is a first-line systemic therapy that is generally safe and effective for psoriasis, but it req
38
Tinea manuum is a dermatophyte infection that often occurs in association with:
A.Tinea pedis
B.Tinea barbae
C.Tinea capitis
D.Tinea cruris
Answer: A. Tinea pedis
Tinea manuum is a dermatophyte infection of the hand and often occurs in association with tinea pedis in a presentation referred to as “two feet—one hand syndrome.” Tinea barbae is a dermatophyte infection of beard hair, tinea capitis is a dermatophyte infection of scalp hair, and tinea cruris is a dermatophyte infection of the crural fold.
39
Which of the following phases of wound healing is characterized by fibroblasts that accumulate and build upon fibrin matrix to produce wound contraction and scar formation and produce essential elements such as collagen?
A.Hemostasis
B.Inflammation
C.Proliferation
D.Remodeling
Answer: D. Remodeling
During remodeling, fibroblasts accumulate and build upon fibrin matrix to produce wound contraction and scar formation and produce essential elements such as collagen. Hemostasis involves constriction of local blood vessels, platelet aggregation, and fibrin (clot) formation. During inflammation, macrophages and lymphocytes proliferate, and inflammatory mediators such as cytokines and leukotrienes are present. The proliferation phase involves proliferation of basal and epithelial cells (angiogenesis).
40
Which form of psoriasis is often preceded by streptococcal infection?
A.Pustular
B.Chronic plaque
C.Guttate
D.Erythrodermic
Answer: C. Guttate
Guttate psoriasis is often preceded by a streptococcal infection; evidence has supported an association between new-onset guttate psoriasis and acute streptococcal pharyngitis in 56% to 97% of patients. The other forms of psoriasis are not preceded by a streptococcal infection.
41
Which diagnostic test is commonly employed to identify the specific allergens responsible for allergic contact dermatitis?
A.Skin prick test
B.Patch test
C.ELISA-based IgE assay
D.Skin biopsy
Answer: B. Patch test
The patch test is a widely used diagnostic tool for identifying specific allergens causing allergic contact dermatitis.
42
An adult patient presents with a 6-week history of dry, itchy, red patches covered with thick, silvery scales, located predominantly on their elbows, knees, and scalp. The person reports a family history of similar skin issues. The nurse practitioner (NP) observes pitting in the patient's fingernails. What diagnostic test should the NP consider to confirm the diagnosis for this patient?
A.KOH (potassium hydroxide) preparation
B.Skin prick allergy test
C.Patch test for contact dermatitis
D.Punch biopsy
Answer: D. Punch biopsy
The patient's symptoms and family history align with a potential diagnosis of psoriasis, which usually presents as itchy, red patches covered with thick, silvery scales, often found on the knees, elbows, and scalp. Nail changes, such as pitting, are also typical of psoriasis. A punch biopsy allows for the histopathological examination of the skin and can provide a definitive diagnosis.
43
A 12-month-old child presents to the pediatric clinic with a history of high fever that lasted for several days, followed by the sudden onset of a rash. The child's parent reports that the fever resolved just before the appearance of the rash. Which of the following findings would support the diagnosis of roseola infantum?
A.Maculopapular rash starting on the face and spreading to the trunk and extremities
B.Vesicular rash limited to the perioral area and the hands
C.Erythematous rash with a sandpaper-like texture and a circumoral pallor
D.Honey-crusted lesions with a "stuck-on" appearance, predominantly on the face
Answer: A. Maculopapular rash starting on the face and spreading to the trunk and extremities
Roseola infantum is characterized by a maculopapular rash that typically starts on the face and spreads to the trunk and extremities. The rash is pink or rose-colored and is not pruritic. The appearance of the rash after the resolution of high fever is a distinguishing feature of roseola infantum. A vesicular rash limited to the perioral area and hands is suggestive of hand, foot, and mouth disease. An erythematous rash with a sandpaper-like texture and a circumoral pallor is characteristic of scarlet fever. The rash in scarlet fever typically starts on the neck and spreads to the trunk and extremities. Honey-crusted lesions with a "stuck-on" appearance, predominantly on the face, are characteristic of impetigo, a bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. Impetigo is characterized by superficial skin lesions that can be vesicular or pustular and are commonly found on the face.
44
A patient presents to the clinic with severe pain in the right thigh that started 48 hours ago. The area is erythematous, swollen, and warm to touch and has a purplish hue. The patient reports a history of intravenous drug use and a fever of 102°F at home. Despite these symptoms, the patient is hemodynamically stable and alert. What is the most likely diagnosis?
A.Deep vein thrombosis
B.Cellulitis
C.Necrotizing fasciitis
D.Osteomyelitis
Answer: C. Necrotizing fasciitis
Given the patient's history of intravenous drug use as well as the severe pain, fever, and the rapid progression of erythema with a purplish hue, the clinical presentation is most concerning for necrotizing fasciitis. This is a rapidly progressive and potentially life-threatening bacterial skin infection that requires immediate surgical intervention. Deep vein thrombosis could present with a swollen, painful limb, but it is less likely given the presence of fever and rapidly progressing skin changes, as well as the patient’s history of intravenous drug use, a risk factor for necrotizing fasciitis. Cellulitis is a more common skin infection that typically presents with redness, swelling, and pain, but it does not usually cause the severe pain and rapidly progressive skin changes seen in necrotizing fasciitis. Osteomyelitis is an infection of the bone that can cause pain and swelling over the affected area, as well as fever. However, the rapid progression of skin changes is more suggestive of a soft tissue infection like necrotizing fasciitis.
45
Which of the following is a palpable lesion measuring <1 cm in diameter?
A.Macule
B.Plaque
C.Papule
D.Vesicle
Answer: C. Papule
Papules are palpable, discrete lesions measuring <1 cm in diameter. Macules are nonpalpable lesions measuring <1 cm that vary in pigmentation from the surrounding skin. Plaques are elevated lesions that are >1 cm in diameter. Vesicles are small (<1 cm in diameter), circumscribed skin papules that are filled with clear serous or hemorrhagic fluid.
46
What should be monitored in a patient receiving long-term systemic corticosteroid therapy?
A.Hemoglobin A1C
B.Serum electrolytes
C.Bone mineral density
D.Liver enzymes
Answer: C. Bone mineral density
Monitoring bone mineral density through dual-energy x-ray absorptiometry (DEXA) scans is recommended in patients receiving long-term systemic corticosteroid therapy due to the increased risk of osteoporosis and fractures associated with corticosteroid use. Hemoglobin A1C is primarily used for monitoring long-term glycemic control in patients with diabetes. Serum electrolytes are not directly affected by long-term corticosteroid therapy. Liver enzymes are primarily monitored in the context of liver diseases or when specific medications have hepatotoxic potential.
47
Where are the apocrine sweat glands primarily located?
A.Palms of the hands
B.Soles of the feet
C.Forehead
D.Axillary and anogenital areas
Answer: D. Axillary and anogenital areas
The apocrine sweat glands are located mainly in the axilla and groin. Dormant until puberty, they release water, salt, fatty acids, and proteins into hair follicles. Eccrine glands are the major sweat glands of the body, widely distributed but greatest in the hands, soles of the feet, and forehead. They help with heat dissipation and thermoregulation.
48
A patient with chronic urticaria has failed to respond adequately to second-generation antihistamines. Which treatment option would be the most appropriate next step for this patient's refractory chronic urticaria?
A.Montelukast (Singulair)
B.Omalizumab (Xolair)
C.Cetirizine (Zyrtec)
D.Cromolyn sodium (Gastrocrom)
Answer: B. Omalizumab (Xolair)
For patients with refractory chronic urticaria who do not respond to second-generation antihistamines, treatment with omalizumab (Xolair), a monoclonal antibody targeting IgE, has shown effectiveness in improving symptoms.
49
A 9-year-old patient presents with a fever, headache, abdominal pain, and a rash that started on the wrists and ankles and spread centrally. The parents report a recent tick bite. The nurse practitioner diagnoses the patient based on presenting symptoms and on which of the following laboratory findings?
A.Elevated white blood cell (WBC) count with left shift
B.Thrombocytopenia and elevated liver enzymes
C.Positive throat culture for group A Streptococcus
D.Presence of antinuclear antibodies (ANAs)
Answer: B. Thrombocytopenia and elevated liver enzymes
In pediatric patients suspected of having Rocky Mountain spotted fever, laboratory findings that support the diagnosis include thrombocytopenia (low platelet count) and elevated liver enzymes. Thrombocytopenia occurs due to platelet destruction and consumption in the context of vasculitis, while elevated liver enzymes (such as alanine aminotransferase and aspartate aminotransferase) indicate liver involvement. These findings, along with the characteristic clinical features, can help confirm the diagnosis of Rocky Mountain spotted fever. While an elevated WBC count can be seen in infectious diseases, it is not a specific finding for Rocky Mountain spotted fever. Additionally, a left shift (increase in immature forms of WBCs) is not typically associated with this condition. A positive throat culture for group A Streptococcus indicates a streptococcal infection, such as strep throat, but it is not associated with the diagnosis of Rocky Mountain spotted fever, and the patient’s clinical presentation is not suggestive of a streptococcal infection. The presence of ANAs is associated with autoimmune conditions and is not specific to Rocky Mountain spotted fever. ANA testing is not a diagnostic tool for this disease.
50
A patient presents with severe, sudden-onset pain in the lower leg that started 24 hours ago. On examination, there is diffuse swelling and erythema but no crepitus. The pain is disproportionate to the physical findings. The patient is afebrile but appears anxious and is tachycardic. The patient had a minor abrasion on the same leg a few days ago. What would be the most appropriate next step?
A.Order a complete blood count with differential
B.Order an MRI of the lower leg
C.Initiate broad-spectrum antibiotics immediately
D.Refer the patient to the ED for surgical consultation
Answer: D. Refer the patient to the ED for surgical consultation
The patient's severe, disproportionate pain, tachycardia, anxiety, and recent minor trauma suggest a possible diagnosis of necrotizing fasciitis, a rapidly progressive and potentially life-threatening bacterial skin infection. Immediate surgical consultation is crucial because early surgical debridement is a key component of management, in addition to antibiotics. This typically requires hospitalization and may involve intensive care, so an immediate referral to the ED is the most appropriate next step. A complete blood count with differential could provide information about the body's response to infection, but it would not confirm the diagnosis of necrotizing fasciitis, and the urgency of this condition necessitates more immediate action. An MRI of the lower leg could provide evidence of necrotizing fasciitis, but obtaining this imaging study could delay definitive treatment. Time is crucial in managing necrotizing fasciitis to prevent morbidity and mortality. While it is important to initiate broad-spectrum antibiotics in a suspected case of necrotizing fasciitis, this should be done in parallel with immediate surgical consultation. Delaying referral for surgical evaluation could lead to a worse outcome.
51
A child presents with multiple scaly patches with hair loss. Multiple black dots are present at follicular orifices within areas of alopecia. First-line treatment for this condition includes which of the following?
A.Fluconazole
B.Ketoconazole
C.Nystatin
D.Griseofulvin
Answer: D. Griseofulvin
This patient is presenting with tinea capitis. The most common manifestation is scaly patches with alopecia and patches of alopecia with black dots at follicular orifices that represent broken hairs. The most commonly used therapies in children are oral griseofulvin and oral terbinafine; griseofulvin is considered first-line therapy based on its efficacy. Oral fluconazole can be used as an alternative therapy but is less frequently used and is not considered first line. Oral ketoconazole is no longer recommended due to its risk of severe liver injury and drug interactions. Nystatin is not effective for dermatophyte infections (it is indicated for cutaneous Candida infections).
52
A 5-year-old patient presents with a rash consisting of pinkish-red maculopapular lesions that started on the face and spread downward to the trunk and extremities. The child’s temperature is normal. The child is otherwise healthy and does not have any significant medical conditions. Which of the following statements accurately describes the appropriate treatment approach for this patient?
A.Administering antiviral therapy with acyclovir to reduce viral replication
B.Prescribing antibiotics such as amoxicillin to prevent secondary bacterial infections
C.Providing supportive care including rest, hydration, and antipyretics if necessary
D.Initiating corticosteroid therapy to alleviate symptoms and promote faster recovery
Answer: C. Providing supportive care including rest, hydration, and antipyretics if necessary
The patient is presenting with rubella infection. Rubella is a viral infection caused by the rubella virus, and there is no specific antiviral therapy available for its treatment. The primary approach to managing rubella in an otherwise healthy child involves supportive care. This includes ensuring adequate rest, maintaining hydration, and providing antipyretics such as acetaminophen or ibuprofen if necessary to manage fever and discomfort. Administering antiviral therapy with acyclovir is not appropriate for the treatment of rubella. Acyclovir is an antiviral medication commonly used for herpesvirus infections, but it is not effective against the rubella virus. Prescribing antibiotics such as amoxicillin is not indicated for the treatment of rubella. Rubella is a viral infection, and antibiotics are not effective against viral pathogens. Antibiotics should only be used if there is a concurrent bacterial infection or complication. Initiating corticosteroid therapy is not recommended for the treatment of uncomplicated rubella. Corticosteroids may have limited benefits and potential risks in the management of viral infections like rubella. They are typically reserved for specific complications or severe manifestations, which are not present in an otherwise healthy child with uncomplicated rubella.
53
A patient presents with a circular rash on their arm and reports recent outdoor activities in an area known for ticks. What diagnostic test should be performed?
A.Western blot test
B.Immunofluorescence assay (IFA)
C.Enzyme-linked immunosorbent assay (ELISA)
D.None; no testing required
Answer: B. Immunofluorescence assay (IFA)
The presence of a circular rash following potential tick exposure suggests a strong possibility of early Lyme disease. In cases like this, diagnosis is frequently made on clinical presentation, and empirical treatment for Lyme disease is initiated without waiting for serologic confirmation. If the patient initially presents with symptoms of late disease, such as swelling and pain in the joints, testing consisting of ELISA or IFA followed by Western blot is appropriate.
54
A patient presents with a severe sunburn to their chest. The skin is intact, and the site is dry and red and blanches with pressure. In general, first-line treatment for this type of burn includes which of the following?
A.Application of topical zinc oxide after the skin heals
B.Cleansing of the wound with povidone-iodine and then covering it with a dressing
C.Cleansing of the wound with mild soap and room-temperature water
D.Application of a topical antimicrobial agent
Answer: C. Cleansing of the wound with mild soap and room-temperature water
This patient is presenting with a superficial burn due to exposure to ultraviolet light (recent sunburn). Treatment of minor burns includes cooling with room-temperature water or ice packs to provide some pain relief.
55
A patient with diabetes and a prior history of cellulitis presents with yellow to brown discoloration of more than 50% of the nail of the great toe. The nail is opaque and thickened with separation of the nail plate from the nail bed. First-line treatment for this condition includes which of the following?
A.Topical efinaconazole
B.Oral ketoconazole
C.Topical ciclopirox
D.Oral terbinafine
Answer: D. Oral terbinafine
The patient is presenting with clinical features suggestive of onychomycosis. Treatment is not necessary for all patients but is recommended for patients with diabetes or a history of cellulitis, patients with pain or discomfort with infected nails, immunosuppressed patients, and patients who desire treatment for cosmetic purposes. This patient meets the criteria for moderate to severe dermatophyte onychomycosis because the dermatophyte onychomycosis involves more than 50% of the nail. First-line treatment is oral terbinafine. Topical therapies (e.g., efinaconazole, ciclopirox) are treatment options for mild to moderate onychomycosis. Oral ketoconazole is not recommended due to the risk of life-threatening hepatotoxicity, adrenal insufficiency, and multiple drug interactions.
56
Which of the following is a super-high potency (group 1) topical steroid?
A.Halcinonide cream
B.Mometasone furoate
C.Fluocinolone acetonide
D.Halobetasol propionate
Answer: D. Halobetasol propionate
Halobetasol propionate is a super-high potency (class 1) topical steroid. Halcinonide is high potency (class 2), mometasone furoate is medium potency (class 4), and fluocinolone acetonide is low potency (class 6).
57
An older adult patient with a past medical history of a venous leg ulcer presents with skin erythema, edema, and warmth on their left lower extremity. Purulent drainage is noted. The patient reports recent antibiotic use for community-acquired pneumonia. The patient’s vital signs are stable, and there is no concern for systemic illness. Which of the following antibiotic regimens is appropriate for this patient?
A.Trimethoprim-sulfamethoxazole
B.Dicloxacillin
C.Doxycycline
D.Cephalexin
Answer: A. Trimethoprim-sulfamethoxazole
The patient is presenting with signs and symptoms of cellulitis. Predisposing factors associated with risk for cellulitis include a skin barrier disruption due to trauma (e.g., venous leg ulcer). Cellulitis presents as areas of skin erythema, edema, and warmth that are nearly always unilateral. The lower extremities are the most common areas of involvement. Cellulitis can be purulent or non-purulent. Patients without signs or symptoms of sepsis can be managed outpatient with antibiotics. This patient has an indication for methicillin-resistant Staphylococcus aureus (MRSA) coverage due to their recent antibiotic use. Patients without severe sepsis with an indication for MRSA coverage should be treated with trimethoprim-sulfamethoxazole or amoxicillin plus doxycycline. Patients without severe sepsis without an indication for MRSA coverage can be treated with dicloxacillin, cephalexin, or cefadroxil.
58
A 35-year-old patient with a history of tinea versicolor presents for a follow-up visit. They have been successfully treated in the past with oral antifungal medication, which resolved their symptoms. However, they now report experiencing recurrent episodes of tinea versicolor. What will the nurse practitioner recommend as the most appropriate measure to prevent future recurrences?
A.Daily use of a broad-spectrum sunscreen
B.Regular application of an antifungal powder to skin folds
C.Using an over-the-counter corticosteroid cream during flare-ups
D.Using a mild soap and avoiding oil-based moisturizers
Answer: B. Regular application of an antifungal powder to skin folds
Recurrent tinea versicolor can be prevented by maintaining good skin hygiene and reducing the overgrowth of Malassezia yeast. Regular application of an antifungal powder, such as one containing miconazole or clotrimazole, to skin folds can help create an unfavorable environment for fungal growth and reduce the risk of recurrence. The primary preventive measure for recurrent episodes is addressing the underlying fungal overgrowth. Sunscreen can help protect the skin from harmful UV rays but will not directly prevent the recurrence of tinea versicolor. Corticosteroid creams can reduce inflammation and itching, but they do not address the underlying fungal infection. The use of corticosteroid creams without concurrent antifungal treatment may worsen the condition by promoting fungal overgrowth. The use of a mild soap and avoidance of oil-based moisturizers alone may not be sufficient to prevent recurrent episodes. Fungal overgrowth requires targeted antifungal measures to effectively manage and prevent tinea versicolor.
59
A patient presents to the clinic complaining of a painful, swollen area on their neck that has been growing over the past week. On examination, the nurse practitioner notes a 1-cm erythematous nodule with a yellowish center. The patient has a fever of 100.4°F and reports malaise. The patient mentions that they have had similar, although smaller, lesions on their neck and face in the past that resolved without intervention. What next step would be most appropriate to confirm the suspected diagnosis?
A.Order a complete blood count with differential
B.Obtain a bacterial culture from the lesion
C.Order an MRI of the neck
D.Perform a punch biopsy of the lesion
Answer: B. Obtain a bacterial culture from the lesion
The patient's presentation of a painful, erythematous nodule with a purulent center is suggestive of a furuncle (boil), which is often caused by Staphylococcus aureus. The most definitive diagnostic step would be to obtain a bacterial culture from the lesion to confirm the presence of Staphylococcus aureus or identify any other causative bacteria. A complete blood count with differential might show an elevated white blood cell count if the infection is severe or systemic, but it would not definitively diagnose a furuncle or identify the causative organism. An MRI of the neck would not be a first-line diagnostic tool for a furuncle, given the invasive nature and cost of MRI and the straightforward clinical presentation of a furuncle. Performing a punch biopsy of the lesion could help in diagnosing certain skin conditions, but it is typically not necessary for diagnosing a furuncle, which can often be diagnosed based on clinical examination and confirmed with culture. Moreover, a punch biopsy could potentially exacerbate the existing infection.
60
A 6-year-old patient is diagnosed with measles. Which of the following instructions is most appropriate for the nurse practitioner to include in the teaching plan for the parents?
A."Since the rash is already present, it is likely that your child is no longer infectious."
B."Keep the child isolated until all symptoms, including fever, have resolved."
C."Your child now has an elevated risk for measles infection later in life."
D."You should expect the cough to resolve within a day or two."
Answer: B. "Keep the child isolated until all symptoms, including fever, have resolved."
Measles is highly contagious, and isolation is necessary to prevent the spread of the virus to others. The child should be kept away from school, daycare, and other public places until they are no longer contagious. According to Centers for Disease Control and Prevention (CDC) guidelines, this isolation period typically lasts for about 4 days after the onset of the rash and until the child is fever-free without the use of antipyretics. Although it is possible to be infected with measles more than once, most children develop immunity after the initial infection. The cough that accompanies measles can persist for 2 to 3 weeks after the rash resolves.
61
A patient has been diagnosed with moderate atopic dermatitis (AD) affecting the flexural areas. Which of the following would be the most appropriate first-line treatment option?
A.Systemic corticosteroids
B.Topical corticosteroids
C.Topical calcineurin inhibitors
D.Antihistamines
Answer: B. Topical corticosteroids
Topical corticosteroids are the first-line treatment for AD. They are effective in reducing inflammation, itching, and redness associated with AD. Their potency is chosen based on the severity of the AD and the location of the affected areas. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are usually reserved for treatment sites on the face or as second-line therapy when patients do not respond well to topical corticosteroids. Systemic corticosteroids can be used for severe AD or acute flare-ups, but due to their side effects and the potential for rebound flares upon discontinuation, they are not a first-line treatment. Antihistamines are typically used as adjunct therapy to relieve itching, especially at night, but they are not the first-line treatment for AD as they do not address the underlying inflammation.
62
What topical medication is commonly used for the treatment of mild to moderate acne vulgaris?
A.Tretinoin
B.Mupirocin
C.Clotrimazole
D.Hydrocortisone
Answer: A. Tretinoin
Tretinoin, a topical retinoid, is commonly used for the treatment of mild to moderate acne vulgaris due to its comedolytic and anti-inflammatory effects. Mupirocin is an antibacterial agent primarily used for the treatment of impetigo or certain bacterial skin infections. Clotrimazole is an antifungal agent used to treat fungal infections. Hydrocortisone is a topical corticosteroid used for its anti-inflammatory properties in various skin conditions; it is not a common treatment for acne vulgaris.
63
Which of the following methods is preferred for confirming the diagnosis of varicella in a pediatric patient?
A.Polymerase chain reaction (PCR) testing
B.Enzyme immunoassay (EIA)
C.Skin biopsy of the vesicular lesion
D.Bacterial culture
Answer: A. Polymerase chain reaction (PCR) testing
Varicella is frequently diagnosed based on clinical presentation. However, when confirmation is necessary, PCR testing for the varicella-zoster virus (VZV) is the preferred method due to its high specificity and sensitivity. It can detect the DNA of the virus from skin lesions or vesicular fluid. EIA can detect antibodies against VZV, and it may be used for serologic testing, but it is less specific and sensitive. While a skin biopsy could reveal histopathological findings consistent with varicella, it is more invasive and less specific than PCR testing. While bacterial culture might be performed if a bacterial superinfection of varicella lesions is suspected, it would not be used to confirm a diagnosis of varicella itself.
64
A burn that extends deeper into the dermis and damages hair follicles and glandular tissue is classified as:
A.Superficial
B.Superficial partial thickness
C.Deep partial thickness
D.Full thickness
Answer: C. Deep partial thickness
Deep partial-thickness burns extend into the deeper dermis and damage hair follicles and glandular tissue. Superficial burns involve only the epidermal layer of skin. Superficial partial-thickness burns form blisters between the epidermis and dermis. Full-thickness burns extend through and destroy all layers of the dermis and often extend into the underlying subcutaneous tissue.
65
A 4-year-old patient presents to the pediatric clinic with a rash consisting of vesicles in different stages of development, accompanied by fever and mild respiratory symptoms. Which of the following findings would support the diagnosis of varicella over other similar conditions?
A.Vesicles are limited to the face and trunk.
B.Vesicles are concentrated on the extremities and palms.
C.Vesicles are preceded by a prodrome of cough, coryza, and conjunctivitis.
D.Vesicles are present only on mucous membranes.
Answer: A. Vesicles are limited to the face and trunk.
In varicella (chickenpox), the rash typically begins on the face and trunk before spreading to other areas of the body. The vesicles are usually in different stages of development, including macules, papules, vesicles, and crusted lesions. If the vesicles were concentrated on the extremities and palms, it would be more suggestive of hand, foot, and mouth disease (HFMD), rather than varicella. HFMD is a viral illness caused by enteroviruses and is characterized by vesicular lesions on the palms, soles, and oral mucosa. The presence of a prodrome of cough, coryza (runny nose), and conjunctivitis is more indicative of viral respiratory infections such as measles or adenovirus infection. In varicella, the prodromal symptoms are usually mild, consisting of low-grade fever and malaise. Vesicles limited to mucous membranes are more suggestive of other conditions, such as herpetic gingivostomatitis.
66
A patient with hidradenitis suppurativa presents with inflammatory lesions and multiple abscess formations without skin tunnels or scarring. This would be classified as which stage of the disease?
A.II
B.III
C.I
D.More information necessary to determine stage
Answer: C. I
A clinical staging system is used to classify patients with hidradenitis suppurativa. Stage I disease involves abscess formation without sinus tracts or scarring; Stage II is defined by recurrent abscesses with skin tunnels and scarring; and Stage III is characterized by multiple interconnected tracts, abscesses, and scarring, with diffuse involvement across an entire area.
