PHR 954 EXAM WITH COMPLETE
SOLUTION
Herpes Simplex Presentation - ANSWER Presents as painful vesicles located on the lips
and face (type 1, fever blister, cold sore) or on the genitals (type 2).
It is usually a chronic, recurrent condition, with acute episodes occurring periodically
and lasting 7 to 10 days.
Herpes Zoster Presentation - ANSWER Appearance of typical painful vesicular lesions.
In shingles rather than occurring in random patterns, the lesions appear in a linear
fashion along skin dermatomes. The vesicular eruption is generally preceded by a
prodrome involving pain and itching lasting several days.
What is a common complication of herpes zoster in adult patients? - ANSWER
Postherpetic neuralgia (PHN), which can last for months or even become permanent. Up
to 40% of patients with shingles develop PHN.
What is the general presentation of tinea infections? - ANSWER Sharply marginated,
have central clearing, and are reddish-brown in color. Their medical names are
determined by location and they have a common appearance regardless of location.
Tinea faciei is located - ANSWER on the face, aka ringworm
Tinea corporis is located - ANSWER on the trunk and lesions are usually asymmetrical
rather than circular
Tinea pedis is located - ANSWER aka as athlete's foot. There are three types of lesions:
dry moccasin like scale on the soles and sides of the feet, interdigital (between the
toes), and vesicular/bullous form.
Tinea cruris - ANSWER also known as jock itch, located in the groin and genital area,
presents like lesions on the face and trunk
How is a candida infection different from a tinea infection in terms of clinical
presentation? - ANSWER Candida infections are usually fiery red, may appear shiny,
and are found in moist or intertriginous areas (i.e., under the breasts, genitals, skin
folds). Candidal skin infections are not sharply marginated, but they have red, popular
"satellite lesions" just outside the main red area. Tineas are usually caused by
dermatophytes such as Trichophyton and Microsporum species.
What is a common predisposing factor to developing a candida infection? - ANSWER
Those who develop candidiasis tend to have compromised immune systems or poorly
,controlled diabetes mellitus.
Acne vulgaris Presentation - ANSWER Typical teenage acne, involves vellus hair follicle
where the hair remains invisible inside the follicle, comedone formation (plugging of the
hair follicle)
Acne rosacea Presentation - ANSWER Primarily on the face in adults. The
papulopustular type has papular lesions and tiny pustule like pimples The
erythematotelangiectatic version presents as persistent erythema of the central face,
with prolonged flushing, burning, or stinging.
What are the signs and symptoms associated with systemic inflammatory response
syndrome (SIRS)? - ANSWER Signs include temperature greater than 38 degrees
Celsius or less than 36 degrees Celsius, tachypnea so greater than 24 breaths per
minute, tachycardia so greater than 90 beats per minute, or white blood cell count
greater than 12,000 or less than 400 cells/microliter.
Ecthyma Presentation and Treatment - ANSWER Treatment: Dicloxacillin or cephalexin,
when MRSA is suspected or confirmed, doxycycline, clindamycin, or
sulfamethoxazole-trimethoprim is recommended
A deeper infection than impetigo, lesions begin as vesicles that rupture, resulting in
circular, erythematous ulcers with adherent crusts, often with surrounding
erythematous edema. Heals with scarring
Impetigo Presentation and Treatment - ANSWER Treatment of bullous or and
non-bullous impetigo should be either topical mupirocin or retapamulin twice daily for 5
days.
Usually presents with a yellow or honey colored crust of serosanguineous fluid.
How long should oral therapy be for ecthyma or impetigo? - ANSWER Oral therapy for
ecthyma or impetigo should be a 7-day regimen with an active agent against S. aureus
unless cultures yield streptococci alone
Cutaneous abscess Presentation - ANSWER Collections of pus within the dermis and
deeper skin tissues, they are usually painful, tender, and fluctuant red nodules, often
surmounted by a pustule and encircled by a rim of erythematous swelling.
Furuncle Presentation - ANSWER aka as a "boil", is a local cellulitis, arising from a
single hair follicle. Some are abscess like with a purulent center and relatively avascular
core.
Carbuncle Presentation - ANSWER a large furuncle with a larger area of a local cellulitis
that involves multiple hair follicles with connecting sinus tracts between follicles
Folliculitis Presentation - ANSWER a mildly infected hair follicle with little or no cellulitis,
is presents primarily as a pustule surrounding a single hair follicle
,What pathogen do you most suspect as a cause of a cutaneous abscess? - ANSWER S.
aureus
Usually, in mild, simple cases of cutaneous abscesses, incision and drainage is all that's
needed. However, what patient specific factors would make you more inclined to
recommend a course of oral antibiotics? - ANSWER Systemic antibiotics should be given
to patients with severely impaired host defenses or signs or symptoms of systemic
infection. Multiple abscesses, extremes of age, and lack of response to incision and
drainage alone are additional settings in which systemic antimicrobial therapy should
be considered.
What are the general 4-5 symptoms that would suggest bacterial cellulitis? - ANSWER
Lesions are swollen, very warm or hot to the touch, red in color, painful, and sometimes
are associated with purulent material or pus, also they tend to spread or grow if left
untreated
Cellulitis Presentation - ANSWER generic term for a soft tissue bacterial infection
Erysipelas Presentation - ANSWER a. is a cellulitis on the face, which moves very rapidly
along the fascia due to production of hyaluronidase produced by the causative agent
group A beta-hemolytic Streptococcus pyogenes. It produces little or no purulent
material and is a medical emergency due to the close proximity of tracts near the eyes
Necrotizing fasciitis - ANSWER aka flesh eating bacteria, is usually a multiorganism,
mixed aerobe/anaerobe infection including group A beta-hemolytic Streptococcus
pyogenes but can be caused by GABHS alone. GABHS produced hyaluronidase allows
the infection to move along the fascia, quickly destroying surrounding soft tissue.
You are an ED pharmacist and a patient has been bitten by a dog in which the wound
looks infected. The medical resident wants to know what antibiotic you recommend and
why (what pathogens should be considered in animal bites)? - ANSWER
Amoxicillin-clavulanate, anaerobic bacteria. Alternative therapies could include second
generation cephalosporins plus anerobic coverage (clindamycin or metronidazole).
Purulent bite wounds and abscess are more likely to be polymicrobial (mixed aerobes
and anaerobes), whereas non-purulent wounds commonly yield staphylococci and
streptococci.
The medical resident from the last question also reports that the patient cannot
remember when he received his last tetanus shot. He asks if you would recommend the
patient go ahead and receive a tetanus shot and if so, which one: Td or Tdap? - ANSWER
Recommend tetanus shot. Tdap preferred over Td if the former has not been previously
given.
Angioedema - ANSWER Angioedema is self-limited, localized subcutaneous (or
submucosal) swelling, which results from extravasation of fluid into interstitial tissues.
Angioedema may occur in isolation, accompanied by urticaria, or as a component of
anaphylaxis.
, Bulla/Bullae - ANSWER A circumscribed lesion more than 1 cm in diameter that contains
liquid (clear, serous or haemorrhagic)
AKA: Blister
Demarcated/Demarcation - ANSWER Pigmentary demarcation lines are areas of abrupt
transitions from normal skin color to either hyper-pigmented or hypo-pigmented.
They are seen on limbs, face, and sometimes the trunk.
Distal - ANSWER -In medicine refers to parts of the body further away from the center
-The opposite of proximal
Erosion/Erosive - ANSWER A focal loss of the top surface of skin. Since it is superficial,
the skin heals without scarring.
Erythema/Erythematous - ANSWER Red skin due to an increased blood supply; may be
applied to any red coloured dermatosis.
Can result from many different inflammatory or infectious diseases. Cutaneous tumors
are often pink or red. Superficial vascular lesions such as port-wine stains may appear
red.
Erythrodema - ANSWER the term used to describe intense and usually widespread
reddening of the skin due to inflammatory skin disease. It often precedes or is
associated with exfoliation (skin peeling off in scales or layers)
Exanthem/Exanthematous - ANSWER A widespread rash that is usually accompanied by
systemic symptoms (fever, malaise, and headache). Usually caused by a virus and is a
reaction to either a toxin produced by the organism, damage to the skin by the
organism, or an immune response.
Hyperpigmentation - ANSWER Descriptive term for skin color; used to describe areas of
skin that is darker than normal, caused by excess melanin forming deposits in the skin.
May be localized or generalized, and can occur in any skin tone. "Age spots" and "liver
spots" are examples of this phenomenon. Often benign, but can be caused by serious
conditions such as cancer, or may be drug-induced. Typical causative agents include
antibiotics (tetracyclines, trimethoprim, sulfonamides, and fluoroquinolones), NSAIDs,
and barbiturates
Hypopigmentation - ANSWER Hypopigmentation is a condition resulting in lightened
areas of skin that can occur in patches or throughout the body. This condition is a result
of reduced melanin production. This condition can be the result of genetic conditions,
such as albinism or vitiligo, or past injuries/conditions such as burns or infections.
These hypopigmented areas can occur as pale areas or pink areas depending on the
cause of the condition and the ethnicity of the patient.
Lichenification - ANSWER Thickened/Leathery skin with lots of wrinkles indicating a
SOLUTION
Herpes Simplex Presentation - ANSWER Presents as painful vesicles located on the lips
and face (type 1, fever blister, cold sore) or on the genitals (type 2).
It is usually a chronic, recurrent condition, with acute episodes occurring periodically
and lasting 7 to 10 days.
Herpes Zoster Presentation - ANSWER Appearance of typical painful vesicular lesions.
In shingles rather than occurring in random patterns, the lesions appear in a linear
fashion along skin dermatomes. The vesicular eruption is generally preceded by a
prodrome involving pain and itching lasting several days.
What is a common complication of herpes zoster in adult patients? - ANSWER
Postherpetic neuralgia (PHN), which can last for months or even become permanent. Up
to 40% of patients with shingles develop PHN.
What is the general presentation of tinea infections? - ANSWER Sharply marginated,
have central clearing, and are reddish-brown in color. Their medical names are
determined by location and they have a common appearance regardless of location.
Tinea faciei is located - ANSWER on the face, aka ringworm
Tinea corporis is located - ANSWER on the trunk and lesions are usually asymmetrical
rather than circular
Tinea pedis is located - ANSWER aka as athlete's foot. There are three types of lesions:
dry moccasin like scale on the soles and sides of the feet, interdigital (between the
toes), and vesicular/bullous form.
Tinea cruris - ANSWER also known as jock itch, located in the groin and genital area,
presents like lesions on the face and trunk
How is a candida infection different from a tinea infection in terms of clinical
presentation? - ANSWER Candida infections are usually fiery red, may appear shiny,
and are found in moist or intertriginous areas (i.e., under the breasts, genitals, skin
folds). Candidal skin infections are not sharply marginated, but they have red, popular
"satellite lesions" just outside the main red area. Tineas are usually caused by
dermatophytes such as Trichophyton and Microsporum species.
What is a common predisposing factor to developing a candida infection? - ANSWER
Those who develop candidiasis tend to have compromised immune systems or poorly
,controlled diabetes mellitus.
Acne vulgaris Presentation - ANSWER Typical teenage acne, involves vellus hair follicle
where the hair remains invisible inside the follicle, comedone formation (plugging of the
hair follicle)
Acne rosacea Presentation - ANSWER Primarily on the face in adults. The
papulopustular type has papular lesions and tiny pustule like pimples The
erythematotelangiectatic version presents as persistent erythema of the central face,
with prolonged flushing, burning, or stinging.
What are the signs and symptoms associated with systemic inflammatory response
syndrome (SIRS)? - ANSWER Signs include temperature greater than 38 degrees
Celsius or less than 36 degrees Celsius, tachypnea so greater than 24 breaths per
minute, tachycardia so greater than 90 beats per minute, or white blood cell count
greater than 12,000 or less than 400 cells/microliter.
Ecthyma Presentation and Treatment - ANSWER Treatment: Dicloxacillin or cephalexin,
when MRSA is suspected or confirmed, doxycycline, clindamycin, or
sulfamethoxazole-trimethoprim is recommended
A deeper infection than impetigo, lesions begin as vesicles that rupture, resulting in
circular, erythematous ulcers with adherent crusts, often with surrounding
erythematous edema. Heals with scarring
Impetigo Presentation and Treatment - ANSWER Treatment of bullous or and
non-bullous impetigo should be either topical mupirocin or retapamulin twice daily for 5
days.
Usually presents with a yellow or honey colored crust of serosanguineous fluid.
How long should oral therapy be for ecthyma or impetigo? - ANSWER Oral therapy for
ecthyma or impetigo should be a 7-day regimen with an active agent against S. aureus
unless cultures yield streptococci alone
Cutaneous abscess Presentation - ANSWER Collections of pus within the dermis and
deeper skin tissues, they are usually painful, tender, and fluctuant red nodules, often
surmounted by a pustule and encircled by a rim of erythematous swelling.
Furuncle Presentation - ANSWER aka as a "boil", is a local cellulitis, arising from a
single hair follicle. Some are abscess like with a purulent center and relatively avascular
core.
Carbuncle Presentation - ANSWER a large furuncle with a larger area of a local cellulitis
that involves multiple hair follicles with connecting sinus tracts between follicles
Folliculitis Presentation - ANSWER a mildly infected hair follicle with little or no cellulitis,
is presents primarily as a pustule surrounding a single hair follicle
,What pathogen do you most suspect as a cause of a cutaneous abscess? - ANSWER S.
aureus
Usually, in mild, simple cases of cutaneous abscesses, incision and drainage is all that's
needed. However, what patient specific factors would make you more inclined to
recommend a course of oral antibiotics? - ANSWER Systemic antibiotics should be given
to patients with severely impaired host defenses or signs or symptoms of systemic
infection. Multiple abscesses, extremes of age, and lack of response to incision and
drainage alone are additional settings in which systemic antimicrobial therapy should
be considered.
What are the general 4-5 symptoms that would suggest bacterial cellulitis? - ANSWER
Lesions are swollen, very warm or hot to the touch, red in color, painful, and sometimes
are associated with purulent material or pus, also they tend to spread or grow if left
untreated
Cellulitis Presentation - ANSWER generic term for a soft tissue bacterial infection
Erysipelas Presentation - ANSWER a. is a cellulitis on the face, which moves very rapidly
along the fascia due to production of hyaluronidase produced by the causative agent
group A beta-hemolytic Streptococcus pyogenes. It produces little or no purulent
material and is a medical emergency due to the close proximity of tracts near the eyes
Necrotizing fasciitis - ANSWER aka flesh eating bacteria, is usually a multiorganism,
mixed aerobe/anaerobe infection including group A beta-hemolytic Streptococcus
pyogenes but can be caused by GABHS alone. GABHS produced hyaluronidase allows
the infection to move along the fascia, quickly destroying surrounding soft tissue.
You are an ED pharmacist and a patient has been bitten by a dog in which the wound
looks infected. The medical resident wants to know what antibiotic you recommend and
why (what pathogens should be considered in animal bites)? - ANSWER
Amoxicillin-clavulanate, anaerobic bacteria. Alternative therapies could include second
generation cephalosporins plus anerobic coverage (clindamycin or metronidazole).
Purulent bite wounds and abscess are more likely to be polymicrobial (mixed aerobes
and anaerobes), whereas non-purulent wounds commonly yield staphylococci and
streptococci.
The medical resident from the last question also reports that the patient cannot
remember when he received his last tetanus shot. He asks if you would recommend the
patient go ahead and receive a tetanus shot and if so, which one: Td or Tdap? - ANSWER
Recommend tetanus shot. Tdap preferred over Td if the former has not been previously
given.
Angioedema - ANSWER Angioedema is self-limited, localized subcutaneous (or
submucosal) swelling, which results from extravasation of fluid into interstitial tissues.
Angioedema may occur in isolation, accompanied by urticaria, or as a component of
anaphylaxis.
, Bulla/Bullae - ANSWER A circumscribed lesion more than 1 cm in diameter that contains
liquid (clear, serous or haemorrhagic)
AKA: Blister
Demarcated/Demarcation - ANSWER Pigmentary demarcation lines are areas of abrupt
transitions from normal skin color to either hyper-pigmented or hypo-pigmented.
They are seen on limbs, face, and sometimes the trunk.
Distal - ANSWER -In medicine refers to parts of the body further away from the center
-The opposite of proximal
Erosion/Erosive - ANSWER A focal loss of the top surface of skin. Since it is superficial,
the skin heals without scarring.
Erythema/Erythematous - ANSWER Red skin due to an increased blood supply; may be
applied to any red coloured dermatosis.
Can result from many different inflammatory or infectious diseases. Cutaneous tumors
are often pink or red. Superficial vascular lesions such as port-wine stains may appear
red.
Erythrodema - ANSWER the term used to describe intense and usually widespread
reddening of the skin due to inflammatory skin disease. It often precedes or is
associated with exfoliation (skin peeling off in scales or layers)
Exanthem/Exanthematous - ANSWER A widespread rash that is usually accompanied by
systemic symptoms (fever, malaise, and headache). Usually caused by a virus and is a
reaction to either a toxin produced by the organism, damage to the skin by the
organism, or an immune response.
Hyperpigmentation - ANSWER Descriptive term for skin color; used to describe areas of
skin that is darker than normal, caused by excess melanin forming deposits in the skin.
May be localized or generalized, and can occur in any skin tone. "Age spots" and "liver
spots" are examples of this phenomenon. Often benign, but can be caused by serious
conditions such as cancer, or may be drug-induced. Typical causative agents include
antibiotics (tetracyclines, trimethoprim, sulfonamides, and fluoroquinolones), NSAIDs,
and barbiturates
Hypopigmentation - ANSWER Hypopigmentation is a condition resulting in lightened
areas of skin that can occur in patches or throughout the body. This condition is a result
of reduced melanin production. This condition can be the result of genetic conditions,
such as albinism or vitiligo, or past injuries/conditions such as burns or infections.
These hypopigmented areas can occur as pale areas or pink areas depending on the
cause of the condition and the ethnicity of the patient.
Lichenification - ANSWER Thickened/Leathery skin with lots of wrinkles indicating a
