NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
A 63-year-old male presents with an asymptomaticlesion in his mouth that was
discovered by his dentist at a check-up.It is ill marginated with pigment ranging
from medium brown to black.Parts of the lesion are raised. What is the next
appropriate stepin management?
Oropharyngeal melanoma is characterized by varying pigment occurringin an
irregularly shaped lesion. Although this is a rarely occurringmelanoma, a biopsy
should be done and any pigmented oral lesionshould be excised. Areas which are
raised within the lesion usuallyindicate sites of invasion.
What is the appropriate first line treatment of lyme disease in a non-pregnant adult
female with erythema migrans and no other symptoms of lyme disease and no
known drug allergies?
In patients over the age of 9 exhibiting skin or joint manifestations of lyme disease,
the first line treatment is Doxycycline 100 mg bid. Patients less than 9 or those who
are allergic to Doxycycline should be treated with amoxicillin. Erythromycin is fourth
line treatment for all age groups. Ceftriaxone is first line for patients with nervous
system involvement. (Wolf f & Johnson, pg 691)
A two-year-old male presents with a noduleon the side of his index finger. His
mother states that he has hadthis nodule on one prior occurrence during infancy,
and it resolved onits own. What is the most likely diagnosis?
This child has a recurrent digital fibroma. It is a smooth, firm,pink nodule that occurs
on the fingers and toes up through earlychildhood. Surgical excision is
recommended so that the functionof the digit is not impaired.
A 12-year-old male presents with hyperkeratoticpapules located on both hands.
What is the causative organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the
human papillomavirus(HPV). They can affect patients of any age and can occur on
anyskin surface. There is a predilection for the hands and fingers.
A 12-year-old male presents with hyperkeratoticpapules located on both hands.
What is the causative organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the
human papillomavirus(HPV). They can affect patients of any age and can occur on
anyskin surface. There is a predilection for the hands and fingers.
A 60-year-old male presents with complaints of irritation and a white plaque on his
tongue. He denies pain. During physical exam you are unable to remove the white
plaque from the mucosa with a tongue depressor. What is the most likely diagnosis,
represented as follows?
Oral leukoplakia cannot be removed from the mucosa using a tongue depressor like
,NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
oral thrush can. Lichen planus can mimic candidiasis, squamous cell carcinoma, or
hyperkeratosis, and requires a biopsy to diagnose. Glossitis is a generalized
inflammation, and loss of papillae of the tongue is caused by vitamin deficiencies,
medication reactions, auto immune reactions, or psoriasis. Geographic tongue is an
asymptomatic serpiginous area of atrophy and erythema of the anterior tongue. The
condition is self-limiting.
Digital Fibroma
Acanthosis nigricans
A 54 year old male presents with dark thickened skin and soft pedunculated papules
around his neck. He states that the lesions are asymptomatic. What disease process
are the findings commonly associated with?
The thick dark plaque around the patient's neck is acanthosis nigricans. The papules
are acrochordons (or skin tags). Both conditions are associated with metabolic
syndrome. (Wolf f & Johnson, p231)
A 45-year-old male presents with purulent discharge from his right ear for three
weeks. He states that despite being treated by his family doctor for an ear infection
one month ago, the problem continues to get worse. Upon exam, you note purulent
discharge in the ear canal, an erythemic tympanic membrane, and a possible
perforation. What are the pathogens most likely to culture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a
complication of acute otits media with perforation. Pathogens that culture from
these infections are usually pseudomonas, proteus, or staphylococcus aureus. Strep
pneumoniae is often seen in acute otitis media. E.coli is a urinary tract pathogen.
Candida albicans is a cause of vaginitis, and mycoplasma is a respiratory pathogen.
A six-month-old male has recurrent diaper rashes, which are not responding to
ketoconazole cream or zinc oxide diaper creams. Physical exam shows well
demarcated perianal erythema, with scattered red papules on the buttocks. A KOH
is negative. What would appropriate management include?
This rash is consistent with a perianal staph or strep infection. This bacterial
infection is easily treated with topical mupirocin. If the rash does not resolve after
,NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
two weeks of topical treatment, treatment with an oral antibiotic such as Keflex is
usually successful. Treatment with a topical steroid may worsen the infection.
Tretinoin is a topical retinoid indicated to treat acne, and is not appropriate for
this patient. Lotrisone is a combination medication that includes an antifungal and
a topical steroid, neither of which is indicated in this patient.
You are evaluating an 80-year-old female for the first time. She has a history of mild
Alzheimer's disease, for which she takes Aricept. She states that she feels fine but
her daughter feels she is depressed and has been complaining of not feeling well.
Her daughter admits that the patient has a history of primary hyperparathyroidism.
What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
The hallmark of primary hyperparathyroidism is a high serum calcium and high
intact PTH. A low intact PTH is consistent with hypoparathyroidism. The urine serum
calcium is usually high in primary hyperparathyroidism. Cortisol is related to
endocrine conditions affecting the adrenal cortex.
A 65-year-old female presents with a red irritation in her right eye. She states that
this has been occurring intermittently for about two years. She also states that her
eyelids are "droopy," and that she needs plastic surgery. On physical exam you
notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid. What is
the most likely diagnosis for the abnormal physical finding?
Ectropion
Ageing causes a relaxation of the obicularis oris muscle, and will cause the lower
eyelid to sag outwardly. This prevents the lower lid from protecting the eye, and
frequently results in exposure conjunctivitis and keratitis. Treatment is surgical.
A patient presents with epistaxis from the right nares, along with direct pressure to
the nares and elevation of the head. Which of the following is an appropriate initial
treatment?
Phenylephrine is a topical decongestant, and acts as a vasoconstrictor to aid in
stopping minor anterior septal epistaxis. Triamcinolone and momentasone are nasal
steroids used for allergic rhinitis. Cromolyn sodium is a mast cell stabilizer, and
azelastine is a topical H1 selective antihistamine, used for allergic rhinitis.
Keflex
, NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by
bacteria such as pneumonia and bone, ear, skin, and urinary tract infections.
Antibiotics will not work for colds, flu, or other viral infections.
A 15-year-old obese male presents with annularlyconfigured lesions in a generalized
distribution. They are asymptomatic.What can these lesions be associated with?
This patient presents with a generalized form of granuloma annulare(GA).
Generalized GA can be associated with diabetes mellitus.
A 25 year old female presents with multiple irregular brown macules on her upper
back. They are asymptomatic. She has worked as a lifeguard for the past 7 years.
She reports a couple of blistering sunburns and admits to maintaining a "healthy
tan". What is the most likely diagnosis?
Solar lentigines are a result of skin damage from the sun. Unlike ephiledes, they do
not fade once exposure to the sun has stopped. There is no risk of malignancy
associated with solar lentigines.
A 12-year-old presents with sharply demarcated depigmented macules on bilateral
knees. The parents report that this began about one year ago, after the child fell
and skinned his knees. After healing, he was left with these markings. What is the
most likely diagnosis?
Vitiligo is the most likely diagnosis. Vitiligo is an autoimmune disorder that affects
the melanocytes. There is often a history of trauma that can precede an occurrence
of vitiligo. The course for vitiligo is variable. Sometimes it will resolve
spontaneously. Other times, it will continue to progress despite treatment. Post-
inflammatory hypopigmentation are areas of lighter pigment, not complete
depigmentation, which result from a resolved inflammatory process. The pigment
will return over time. A hypertrophic scar is one which is enlarged but stays within
the borders of the original injury. No pigment changes are associated with these
scars. Pityriasis alba is a yeast infection of the skin, and usually appears on the face.
It usually
CORRECT ANSWERS 2022 UPDATE
A 63-year-old male presents with an asymptomaticlesion in his mouth that was
discovered by his dentist at a check-up.It is ill marginated with pigment ranging
from medium brown to black.Parts of the lesion are raised. What is the next
appropriate stepin management?
Oropharyngeal melanoma is characterized by varying pigment occurringin an
irregularly shaped lesion. Although this is a rarely occurringmelanoma, a biopsy
should be done and any pigmented oral lesionshould be excised. Areas which are
raised within the lesion usuallyindicate sites of invasion.
What is the appropriate first line treatment of lyme disease in a non-pregnant adult
female with erythema migrans and no other symptoms of lyme disease and no
known drug allergies?
In patients over the age of 9 exhibiting skin or joint manifestations of lyme disease,
the first line treatment is Doxycycline 100 mg bid. Patients less than 9 or those who
are allergic to Doxycycline should be treated with amoxicillin. Erythromycin is fourth
line treatment for all age groups. Ceftriaxone is first line for patients with nervous
system involvement. (Wolf f & Johnson, pg 691)
A two-year-old male presents with a noduleon the side of his index finger. His
mother states that he has hadthis nodule on one prior occurrence during infancy,
and it resolved onits own. What is the most likely diagnosis?
This child has a recurrent digital fibroma. It is a smooth, firm,pink nodule that occurs
on the fingers and toes up through earlychildhood. Surgical excision is
recommended so that the functionof the digit is not impaired.
A 12-year-old male presents with hyperkeratoticpapules located on both hands.
What is the causative organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the
human papillomavirus(HPV). They can affect patients of any age and can occur on
anyskin surface. There is a predilection for the hands and fingers.
A 12-year-old male presents with hyperkeratoticpapules located on both hands.
What is the causative organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the
human papillomavirus(HPV). They can affect patients of any age and can occur on
anyskin surface. There is a predilection for the hands and fingers.
A 60-year-old male presents with complaints of irritation and a white plaque on his
tongue. He denies pain. During physical exam you are unable to remove the white
plaque from the mucosa with a tongue depressor. What is the most likely diagnosis,
represented as follows?
Oral leukoplakia cannot be removed from the mucosa using a tongue depressor like
,NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
oral thrush can. Lichen planus can mimic candidiasis, squamous cell carcinoma, or
hyperkeratosis, and requires a biopsy to diagnose. Glossitis is a generalized
inflammation, and loss of papillae of the tongue is caused by vitamin deficiencies,
medication reactions, auto immune reactions, or psoriasis. Geographic tongue is an
asymptomatic serpiginous area of atrophy and erythema of the anterior tongue. The
condition is self-limiting.
Digital Fibroma
Acanthosis nigricans
A 54 year old male presents with dark thickened skin and soft pedunculated papules
around his neck. He states that the lesions are asymptomatic. What disease process
are the findings commonly associated with?
The thick dark plaque around the patient's neck is acanthosis nigricans. The papules
are acrochordons (or skin tags). Both conditions are associated with metabolic
syndrome. (Wolf f & Johnson, p231)
A 45-year-old male presents with purulent discharge from his right ear for three
weeks. He states that despite being treated by his family doctor for an ear infection
one month ago, the problem continues to get worse. Upon exam, you note purulent
discharge in the ear canal, an erythemic tympanic membrane, and a possible
perforation. What are the pathogens most likely to culture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a
complication of acute otits media with perforation. Pathogens that culture from
these infections are usually pseudomonas, proteus, or staphylococcus aureus. Strep
pneumoniae is often seen in acute otitis media. E.coli is a urinary tract pathogen.
Candida albicans is a cause of vaginitis, and mycoplasma is a respiratory pathogen.
A six-month-old male has recurrent diaper rashes, which are not responding to
ketoconazole cream or zinc oxide diaper creams. Physical exam shows well
demarcated perianal erythema, with scattered red papules on the buttocks. A KOH
is negative. What would appropriate management include?
This rash is consistent with a perianal staph or strep infection. This bacterial
infection is easily treated with topical mupirocin. If the rash does not resolve after
,NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
two weeks of topical treatment, treatment with an oral antibiotic such as Keflex is
usually successful. Treatment with a topical steroid may worsen the infection.
Tretinoin is a topical retinoid indicated to treat acne, and is not appropriate for
this patient. Lotrisone is a combination medication that includes an antifungal and
a topical steroid, neither of which is indicated in this patient.
You are evaluating an 80-year-old female for the first time. She has a history of mild
Alzheimer's disease, for which she takes Aricept. She states that she feels fine but
her daughter feels she is depressed and has been complaining of not feeling well.
Her daughter admits that the patient has a history of primary hyperparathyroidism.
What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
The hallmark of primary hyperparathyroidism is a high serum calcium and high
intact PTH. A low intact PTH is consistent with hypoparathyroidism. The urine serum
calcium is usually high in primary hyperparathyroidism. Cortisol is related to
endocrine conditions affecting the adrenal cortex.
A 65-year-old female presents with a red irritation in her right eye. She states that
this has been occurring intermittently for about two years. She also states that her
eyelids are "droopy," and that she needs plastic surgery. On physical exam you
notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid. What is
the most likely diagnosis for the abnormal physical finding?
Ectropion
Ageing causes a relaxation of the obicularis oris muscle, and will cause the lower
eyelid to sag outwardly. This prevents the lower lid from protecting the eye, and
frequently results in exposure conjunctivitis and keratitis. Treatment is surgical.
A patient presents with epistaxis from the right nares, along with direct pressure to
the nares and elevation of the head. Which of the following is an appropriate initial
treatment?
Phenylephrine is a topical decongestant, and acts as a vasoconstrictor to aid in
stopping minor anterior septal epistaxis. Triamcinolone and momentasone are nasal
steroids used for allergic rhinitis. Cromolyn sodium is a mast cell stabilizer, and
azelastine is a topical H1 selective antihistamine, used for allergic rhinitis.
Keflex
, NURS DERMATOLOGY|HEENT EXAM QUESTIONS WITH
CORRECT ANSWERS 2022 UPDATE
Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by
bacteria such as pneumonia and bone, ear, skin, and urinary tract infections.
Antibiotics will not work for colds, flu, or other viral infections.
A 15-year-old obese male presents with annularlyconfigured lesions in a generalized
distribution. They are asymptomatic.What can these lesions be associated with?
This patient presents with a generalized form of granuloma annulare(GA).
Generalized GA can be associated with diabetes mellitus.
A 25 year old female presents with multiple irregular brown macules on her upper
back. They are asymptomatic. She has worked as a lifeguard for the past 7 years.
She reports a couple of blistering sunburns and admits to maintaining a "healthy
tan". What is the most likely diagnosis?
Solar lentigines are a result of skin damage from the sun. Unlike ephiledes, they do
not fade once exposure to the sun has stopped. There is no risk of malignancy
associated with solar lentigines.
A 12-year-old presents with sharply demarcated depigmented macules on bilateral
knees. The parents report that this began about one year ago, after the child fell
and skinned his knees. After healing, he was left with these markings. What is the
most likely diagnosis?
Vitiligo is the most likely diagnosis. Vitiligo is an autoimmune disorder that affects
the melanocytes. There is often a history of trauma that can precede an occurrence
of vitiligo. The course for vitiligo is variable. Sometimes it will resolve
spontaneously. Other times, it will continue to progress despite treatment. Post-
inflammatory hypopigmentation are areas of lighter pigment, not complete
depigmentation, which result from a resolved inflammatory process. The pigment
will return over time. A hypertrophic scar is one which is enlarged but stays within
the borders of the original injury. No pigment changes are associated with these
scars. Pityriasis alba is a yeast infection of the skin, and usually appears on the face.
It usually
