UTICA UNIVERSITY NUR 621: HEALTH
PROMOTION & PRIMARY CARE I 100%
CORRECT!
FINAL EXAM COMPREHENSIVE STUDY GUIDE:
DERMATOLOGICAL DISORDERS (2026/2027)
Table of Contents
1. Course Topic Overview: Dermatological Disorders
2. Multiple-Choice Questions (1–30)
3. Answer Key
4. Detailed Rationales
5. High-Yield Review Sheet
1. Course Topic Overview: Dermatological Disorders
Definitions
Dermatological care in advanced practice nursing involves the comprehensive evaluation,
diagnosis, and evidence-based management of skin, hair, and nail conditions. These
encompass acute inflammatory exanthems, chronic autoimmune dermatoses, infectious
eruptions, and pre-malignant or malignant cutaneous lesions.
Pathophysiology
● Inflammatory/Autoimmune: T-cell-mediated hyperproliferation of keratinocytes
(psoriasis), IgE- and T-helper 2 (Th2)-mediated epidermal barrier disruption with filaggrin
mutations (atopic dermatitis), or autoantibody production targeting
desmosomes/hemidesmosomes (pemphigus/pemphigoid).
● Infectious: Cutaneous tissue invasion by fungal dermatophytes (keratin digestion),
bacterial colonization (superficial S. aureus or deep dermis S. pyogenes), or viral
reactivation within neural ganglia (herpes zoster).
● Neoplastic: Cumulative ultraviolet (UV) radiation causing DNA pyrimidine dimer
formation, leading to dysregulated proliferation of basal keratinocytes (BCC), squamous
keratinocytes (SCC), or melanocytes (melanoma).
Risk Factors
, ● Family history of atopy, psoriasis, or skin cancer
● Chronic ultraviolet light exposure (sunbed use, occupational outdoor exposure)
● Immunosuppression (HIV, organ transplant recipients, biologic therapy)
● Environmental/occupational exposure to chemical irritants or sensitizers
● Venous insufficiency, obesity, and diabetes mellitus
Clinical Manifestations
Morphological characterization is the cornerstone of dermatological evaluation:
● Primary Lesions: Macules, papules, patches, plaques, vesicles, bullae, wheals,
nodules, pustules.
● Secondary Lesions: Scales, crusts, erosions, ulcers, fissures, lichenification, atrophy,
scars.
● Configurations & Distributions: Annular, dermatomal, linear, flexural, extensor,
symmetrical, or localized along Langer lines.
Assessment Findings
● Physical Exam: Complete visual and tactile inspection under adequate lighting.
● Key Clinical Signs:
○ Auspitz sign: Pinpoint bleeding after scraping psoriatic scales.
○ Koebner phenomenon: Development of lesions in previously uninjured skin along
lines of trauma.
○ Nikolsky sign: Epidermal sloughing induced by gentle lateral pressure (seen in
SJS/TEN and pemphigus vulgaris).
○ Hutchinson sign: Vesicular involvement of the tip of the nose indicating
nasociliary branch involvement of trigeminal nerve V1 in herpes zoster
ophthalmicus.
Differential Diagnoses
● Psoriasis vs. Tinea corporis vs. Nummular eczema
● Cellulitis vs. Stasis dermatitis vs. Deep vein thrombosis
● Malignant melanoma vs. Dysplastic nevus vs. Seborrheic keratosis
● Stevens-Johnson Syndrome (SJS) vs. Staphylococcal Scalded Skin Syndrome (SSSS)
vs. Erythema multiforme
Diagnostic Testing
● Potassium Hydroxide (KOH) Preparation: Direct microscopic evaluation of skin
scrapings to visualize fungal hyphae/arthrospores.
● Dermoscopy: In-vivo microscopic evaluation of pigment patterns to differentiate benign
nevi from melanoma.
, ● Skin Biopsy: Punch or shave biopsy for histopathological confirmation of suspected
malignancies or inflammatory bullous dermatoses.
● Wood’s Lamp Examination: Ultraviolet illumination (coral red in Corynebacterium
erythrasma, yellow-green in Tinea capitis, depigmentation in vitiligo).
● Patch Testing: Gold standard for diagnosing Type IV delayed hypersensitivity in allergic
contact dermatitis.
Evidence-Based Management
● Topical Steroid Potency Ladder: Utilize Class 1 (ultra-high potency, e.g., clobetasol)
for thick plaques on palms/soles; Class 4-5 (medium potency, e.g., triamcinolone) for
body trunk; Class 6-7 (low potency, e.g., hydrocortisone 1-2.5%) for face, skin folds, and
thin skin to prevent atrophy.
● Systemic Therapies: Step-up therapy using oral DMARDs (methotrexate), oral
antivirals, or targeted biological agents (IL-17, IL-23, TNF-alpha inhibitors) for refractory,
severe, or widespread conditions.
Pharmacological Interventions
● Topical Corticosteroids: Anti-inflammatory mainstay; taper off slowly to avoid rebound
flares.
● Topical Calcineurin Inhibitors: Tacrolimus and pimecrolimus as steroid-sparing
alternatives for facial/intertriginous eczema.
● Oral Retinoids (Isotretinoin): For severe nodulocystic acne; requires strict compliance
with the iPLEDGE safety program.
● Antivirals: Valacyclovir or acyclovir initiated within 72 hours of herpes zoster or herpes
simplex outbreaks.
Non-Pharmacological Interventions
● Emollient repair creams applied within 3 minutes post-bathing ("soak and seal").
● Cool wet-wrap therapy for acute eczema flares.
● Compression therapy (e.g., Unna boots, graduated stocking) for stasis dermatitis once
arterial insufficiency is ruled out.
● Photoprotection (broad-spectrum SPF 30+ daily, sun avoidance during peak UV hours).
Patient Education
● Proper topical application technique utilizing the Fingertip Unit (FTU) standard.
● Strict avoidance of abrupt systemic steroid discontinuation in plaque psoriasis to prevent
life-threatening generalized pustular psoriasis flares.
● Early detection education using the ABCDE rule for melanoma.
Follow-Up Care
PROMOTION & PRIMARY CARE I 100%
CORRECT!
FINAL EXAM COMPREHENSIVE STUDY GUIDE:
DERMATOLOGICAL DISORDERS (2026/2027)
Table of Contents
1. Course Topic Overview: Dermatological Disorders
2. Multiple-Choice Questions (1–30)
3. Answer Key
4. Detailed Rationales
5. High-Yield Review Sheet
1. Course Topic Overview: Dermatological Disorders
Definitions
Dermatological care in advanced practice nursing involves the comprehensive evaluation,
diagnosis, and evidence-based management of skin, hair, and nail conditions. These
encompass acute inflammatory exanthems, chronic autoimmune dermatoses, infectious
eruptions, and pre-malignant or malignant cutaneous lesions.
Pathophysiology
● Inflammatory/Autoimmune: T-cell-mediated hyperproliferation of keratinocytes
(psoriasis), IgE- and T-helper 2 (Th2)-mediated epidermal barrier disruption with filaggrin
mutations (atopic dermatitis), or autoantibody production targeting
desmosomes/hemidesmosomes (pemphigus/pemphigoid).
● Infectious: Cutaneous tissue invasion by fungal dermatophytes (keratin digestion),
bacterial colonization (superficial S. aureus or deep dermis S. pyogenes), or viral
reactivation within neural ganglia (herpes zoster).
● Neoplastic: Cumulative ultraviolet (UV) radiation causing DNA pyrimidine dimer
formation, leading to dysregulated proliferation of basal keratinocytes (BCC), squamous
keratinocytes (SCC), or melanocytes (melanoma).
Risk Factors
, ● Family history of atopy, psoriasis, or skin cancer
● Chronic ultraviolet light exposure (sunbed use, occupational outdoor exposure)
● Immunosuppression (HIV, organ transplant recipients, biologic therapy)
● Environmental/occupational exposure to chemical irritants or sensitizers
● Venous insufficiency, obesity, and diabetes mellitus
Clinical Manifestations
Morphological characterization is the cornerstone of dermatological evaluation:
● Primary Lesions: Macules, papules, patches, plaques, vesicles, bullae, wheals,
nodules, pustules.
● Secondary Lesions: Scales, crusts, erosions, ulcers, fissures, lichenification, atrophy,
scars.
● Configurations & Distributions: Annular, dermatomal, linear, flexural, extensor,
symmetrical, or localized along Langer lines.
Assessment Findings
● Physical Exam: Complete visual and tactile inspection under adequate lighting.
● Key Clinical Signs:
○ Auspitz sign: Pinpoint bleeding after scraping psoriatic scales.
○ Koebner phenomenon: Development of lesions in previously uninjured skin along
lines of trauma.
○ Nikolsky sign: Epidermal sloughing induced by gentle lateral pressure (seen in
SJS/TEN and pemphigus vulgaris).
○ Hutchinson sign: Vesicular involvement of the tip of the nose indicating
nasociliary branch involvement of trigeminal nerve V1 in herpes zoster
ophthalmicus.
Differential Diagnoses
● Psoriasis vs. Tinea corporis vs. Nummular eczema
● Cellulitis vs. Stasis dermatitis vs. Deep vein thrombosis
● Malignant melanoma vs. Dysplastic nevus vs. Seborrheic keratosis
● Stevens-Johnson Syndrome (SJS) vs. Staphylococcal Scalded Skin Syndrome (SSSS)
vs. Erythema multiforme
Diagnostic Testing
● Potassium Hydroxide (KOH) Preparation: Direct microscopic evaluation of skin
scrapings to visualize fungal hyphae/arthrospores.
● Dermoscopy: In-vivo microscopic evaluation of pigment patterns to differentiate benign
nevi from melanoma.
, ● Skin Biopsy: Punch or shave biopsy for histopathological confirmation of suspected
malignancies or inflammatory bullous dermatoses.
● Wood’s Lamp Examination: Ultraviolet illumination (coral red in Corynebacterium
erythrasma, yellow-green in Tinea capitis, depigmentation in vitiligo).
● Patch Testing: Gold standard for diagnosing Type IV delayed hypersensitivity in allergic
contact dermatitis.
Evidence-Based Management
● Topical Steroid Potency Ladder: Utilize Class 1 (ultra-high potency, e.g., clobetasol)
for thick plaques on palms/soles; Class 4-5 (medium potency, e.g., triamcinolone) for
body trunk; Class 6-7 (low potency, e.g., hydrocortisone 1-2.5%) for face, skin folds, and
thin skin to prevent atrophy.
● Systemic Therapies: Step-up therapy using oral DMARDs (methotrexate), oral
antivirals, or targeted biological agents (IL-17, IL-23, TNF-alpha inhibitors) for refractory,
severe, or widespread conditions.
Pharmacological Interventions
● Topical Corticosteroids: Anti-inflammatory mainstay; taper off slowly to avoid rebound
flares.
● Topical Calcineurin Inhibitors: Tacrolimus and pimecrolimus as steroid-sparing
alternatives for facial/intertriginous eczema.
● Oral Retinoids (Isotretinoin): For severe nodulocystic acne; requires strict compliance
with the iPLEDGE safety program.
● Antivirals: Valacyclovir or acyclovir initiated within 72 hours of herpes zoster or herpes
simplex outbreaks.
Non-Pharmacological Interventions
● Emollient repair creams applied within 3 minutes post-bathing ("soak and seal").
● Cool wet-wrap therapy for acute eczema flares.
● Compression therapy (e.g., Unna boots, graduated stocking) for stasis dermatitis once
arterial insufficiency is ruled out.
● Photoprotection (broad-spectrum SPF 30+ daily, sun avoidance during peak UV hours).
Patient Education
● Proper topical application technique utilizing the Fingertip Unit (FTU) standard.
● Strict avoidance of abrupt systemic steroid discontinuation in plaque psoriasis to prevent
life-threatening generalized pustular psoriasis flares.
● Early detection education using the ABCDE rule for melanoma.
Follow-Up Care
