NSG 554 Exam 2 – Wilkes
Questions with Answers| Latest Update|Score 100%
1. A 52-year-old presents with a pigmented lesion on her back. Which
combination of findings is MOST concerning for melanoma?
A. Asymmetry, irregular borders, multiple colors, and a recent increase
in size
B. Small, flat, evenly pigmented lesion with a smooth border
C. Symmetric round lesion, uniform tan color, unchanged for 20 years
D. Waxy, 'stuck-on' brown plaque with keratin-filled pits
Answer: A. Asymmetry, irregular borders, multiple colors, and a
recent increase in size
Rationale: The ABCDE criteria are Asymmetry, Border irregularity, Color
variegation, Diameter >6 mm, and Evolving (change in size, shape, color,
symptoms). Evolution is the single most important warning feature. The
waxy 'stuck-on' description is a seborrheic keratosis.
2. In the ABCDE criteria for melanoma, the letter 'E' refers to:
A. Elevation
B. Erythema
C. Evolving (change over time)
D. Exudate
Answer: C. Evolving (change over time)
Rationale: Any lesion that changes in size, shape, color, or symptoms
(itching, bleeding, crusting) needs evaluation. Patient- or partner-reported
change is a very sensitive indicator.
NR 554 Exam 2 Practice — Page 1
,3. The 'ugly duckling' sign refers to:
A. A lesion that has hair growing from it
B. A lesion larger than 6 mm
C. A lesion that looks different from the patient's other moles
D. A lesion that is uniformly dark
Answer: C. A lesion that looks different from the patient's other moles
Rationale: The ugly duckling sign compares a lesion to the patient's other
nevi; the outlier warrants a closer look and possible biopsy, even if it does
not meet every ABCDE criterion.
4. Which biopsy technique is preferred for a suspected melanoma?
A. Superficial shave biopsy
B. Cryotherapy
C. Curettage
D. Full-thickness excisional biopsy with narrow (1–3 mm) margins
Answer: D. Full-thickness excisional biopsy with narrow (1–3 mm)
margins
Rationale: Full-thickness sampling is needed to measure Breslow depth,
the most important prognostic factor. Shave biopsy can transect the lesion
and prevent accurate staging. If the lesion is too large, a deep punch or
incisional biopsy of the most suspicious area is acceptable.
5. Which prognostic factor is MOST important in staging cutaneous
melanoma?
A. Lesion color
B. Breslow thickness (depth of invasion)
C. Anatomic location alone
D. Patient age
Answer: B. Breslow thickness (depth of invasion)
Rationale: Breslow depth in millimeters drives staging, margin width, and
the need for sentinel node biopsy. Ulceration and mitotic rate also matter.
NR 554 Exam 2 Practice — Page 2
, 6. A 68-year-old farmer has a pearly papule with rolled borders,
telangiectasias, and central ulceration on his nose. What is the MOST
likely diagnosis?
A. Seborrheic keratosis
B. Cherry angioma
C. Squamous cell carcinoma
D. Basal cell carcinoma
Answer: D. Basal cell carcinoma
Rationale: BCC is the most common skin cancer. It is pearly or translucent
with telangiectasias and rolled borders, often with a central ulcer ('rodent
ulcer'). It rarely metastasizes but is locally destructive. Confirm with punch
or shave biopsy.
7. A firm, scaly, erythematous keratotic nodule on the ear of a fair-
skinned man is tender and grows over 2 months. Which diagnosis
should be considered?
A. Acrochordon
B. Squamous cell carcinoma
C. Dermatofibroma
D. Cherry angioma
Answer: B. Squamous cell carcinoma
Rationale: SCC arises on sun-exposed skin, often from actinic keratosis,
and is the skin cancer with more metastatic potential than BCC, particularly
on ears, lips, and in immunosuppressed patients. Biopsy is required.
8. A patient has multiple soft, flesh-colored, pedunculated papules in
the axillae and neck folds. Which associated condition should the NP
screen for?
A. Hemophilia
B. Insulin resistance/type 2 diabetes and obesity
C. Hyperthyroidism
D. Rheumatoid arthritis
Answer: B. Insulin resistance/type 2 diabetes and obesity
Rationale: Acrochordons (skin tags) are benign and associated with
friction, obesity, insulin resistance, and diabetes. Check glucose/A1C.
NR 554 Exam 2 Practice — Page 3
Questions with Answers| Latest Update|Score 100%
1. A 52-year-old presents with a pigmented lesion on her back. Which
combination of findings is MOST concerning for melanoma?
A. Asymmetry, irregular borders, multiple colors, and a recent increase
in size
B. Small, flat, evenly pigmented lesion with a smooth border
C. Symmetric round lesion, uniform tan color, unchanged for 20 years
D. Waxy, 'stuck-on' brown plaque with keratin-filled pits
Answer: A. Asymmetry, irregular borders, multiple colors, and a
recent increase in size
Rationale: The ABCDE criteria are Asymmetry, Border irregularity, Color
variegation, Diameter >6 mm, and Evolving (change in size, shape, color,
symptoms). Evolution is the single most important warning feature. The
waxy 'stuck-on' description is a seborrheic keratosis.
2. In the ABCDE criteria for melanoma, the letter 'E' refers to:
A. Elevation
B. Erythema
C. Evolving (change over time)
D. Exudate
Answer: C. Evolving (change over time)
Rationale: Any lesion that changes in size, shape, color, or symptoms
(itching, bleeding, crusting) needs evaluation. Patient- or partner-reported
change is a very sensitive indicator.
NR 554 Exam 2 Practice — Page 1
,3. The 'ugly duckling' sign refers to:
A. A lesion that has hair growing from it
B. A lesion larger than 6 mm
C. A lesion that looks different from the patient's other moles
D. A lesion that is uniformly dark
Answer: C. A lesion that looks different from the patient's other moles
Rationale: The ugly duckling sign compares a lesion to the patient's other
nevi; the outlier warrants a closer look and possible biopsy, even if it does
not meet every ABCDE criterion.
4. Which biopsy technique is preferred for a suspected melanoma?
A. Superficial shave biopsy
B. Cryotherapy
C. Curettage
D. Full-thickness excisional biopsy with narrow (1–3 mm) margins
Answer: D. Full-thickness excisional biopsy with narrow (1–3 mm)
margins
Rationale: Full-thickness sampling is needed to measure Breslow depth,
the most important prognostic factor. Shave biopsy can transect the lesion
and prevent accurate staging. If the lesion is too large, a deep punch or
incisional biopsy of the most suspicious area is acceptable.
5. Which prognostic factor is MOST important in staging cutaneous
melanoma?
A. Lesion color
B. Breslow thickness (depth of invasion)
C. Anatomic location alone
D. Patient age
Answer: B. Breslow thickness (depth of invasion)
Rationale: Breslow depth in millimeters drives staging, margin width, and
the need for sentinel node biopsy. Ulceration and mitotic rate also matter.
NR 554 Exam 2 Practice — Page 2
, 6. A 68-year-old farmer has a pearly papule with rolled borders,
telangiectasias, and central ulceration on his nose. What is the MOST
likely diagnosis?
A. Seborrheic keratosis
B. Cherry angioma
C. Squamous cell carcinoma
D. Basal cell carcinoma
Answer: D. Basal cell carcinoma
Rationale: BCC is the most common skin cancer. It is pearly or translucent
with telangiectasias and rolled borders, often with a central ulcer ('rodent
ulcer'). It rarely metastasizes but is locally destructive. Confirm with punch
or shave biopsy.
7. A firm, scaly, erythematous keratotic nodule on the ear of a fair-
skinned man is tender and grows over 2 months. Which diagnosis
should be considered?
A. Acrochordon
B. Squamous cell carcinoma
C. Dermatofibroma
D. Cherry angioma
Answer: B. Squamous cell carcinoma
Rationale: SCC arises on sun-exposed skin, often from actinic keratosis,
and is the skin cancer with more metastatic potential than BCC, particularly
on ears, lips, and in immunosuppressed patients. Biopsy is required.
8. A patient has multiple soft, flesh-colored, pedunculated papules in
the axillae and neck folds. Which associated condition should the NP
screen for?
A. Hemophilia
B. Insulin resistance/type 2 diabetes and obesity
C. Hyperthyroidism
D. Rheumatoid arthritis
Answer: B. Insulin resistance/type 2 diabetes and obesity
Rationale: Acrochordons (skin tags) are benign and associated with
friction, obesity, insulin resistance, and diabetes. Check glucose/A1C.
NR 554 Exam 2 Practice — Page 3
