Page |1
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A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after
topical therapies failed. Which first-line treatment is recommended? - Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis
suppurativa.
__________________________________________________
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is
a chronic, disabling disorder that progresses, often causing keloids, contractures, and immobility. It is
characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent
discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and sinus
tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum,
gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor
agents. A dermatology consultation should also be considered.
First-line treatment is a 12-week course of an oral tetracycline (Sumycin) such as doxycycline. For patients
who do not respond to doxycycline, the next recommended step is a combination of twice-daily clindamycin
(Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin (Soriatane, for males and
nonfertile females) or dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to
severe hidradenitis suppurativa, adalimumab (Humira) may possibly be considered.
QUESTION
When providing culturally competent health care services to an American Indian elder, the nurse practitioner
understands which is traditionally true? - The "Medicine Wheel" is used by many for the purpose of
health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west.
Traditionally each tribe has different meanings for each direction and they may represent the season of the
year or stage of life. It is aimed at providing a holistic view of life.
, Page |3
________________________________________
An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients
may value traditional culture and preferences as it relates to healthcare. These individual preferences should
be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health care integrating the person,
lifestyle, environment, family, and religion. Patients adhering to these traditional cultural practices often feel
that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek
care from western medicine for specific ailments while also consulting with traditional healers for spiritual
guidance.
Healthcare providers should seek to understand relevant cultural factors and assess each individual's
healthcare literacy in order to provide culturally competent care.
QUESTION
The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing loss and a
sensation of fullness in the right ear. The nurse practitioner suspects conductive hearing loss. Which could
contribute to this? - Cerumen, commonly called earwax, is a combination of secretions and sloughed
epithelial cells that protects the ears from infection, water, and insects. It is normally expelled from the ear
canal through natural jaw movement. When this self-cleaning process fails, cerumen can become impacted.
Cerumen impaction occludes the ear canal and can press against the tympanic membrane, resulting in
conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive
hearing loss is caused by problems in the external and middle ear that interfere with the transmission of
sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of
the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and
osteomas.
, Page |2
A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after
topical therapies failed. Which first-line treatment is recommended? - Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis
suppurativa.
__________________________________________________
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is
a chronic, disabling disorder that progresses, often causing keloids, contractures, and immobility. It is
characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent
discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and sinus
tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum,
gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor
agents. A dermatology consultation should also be considered.
First-line treatment is a 12-week course of an oral tetracycline (Sumycin) such as doxycycline. For patients
who do not respond to doxycycline, the next recommended step is a combination of twice-daily clindamycin
(Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin (Soriatane, for males and
nonfertile females) or dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to
severe hidradenitis suppurativa, adalimumab (Humira) may possibly be considered.
QUESTION
When providing culturally competent health care services to an American Indian elder, the nurse practitioner
understands which is traditionally true? - The "Medicine Wheel" is used by many for the purpose of
health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west.
Traditionally each tribe has different meanings for each direction and they may represent the season of the
year or stage of life. It is aimed at providing a holistic view of life.
, Page |3
________________________________________
An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients
may value traditional culture and preferences as it relates to healthcare. These individual preferences should
be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health care integrating the person,
lifestyle, environment, family, and religion. Patients adhering to these traditional cultural practices often feel
that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek
care from western medicine for specific ailments while also consulting with traditional healers for spiritual
guidance.
Healthcare providers should seek to understand relevant cultural factors and assess each individual's
healthcare literacy in order to provide culturally competent care.
QUESTION
The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing loss and a
sensation of fullness in the right ear. The nurse practitioner suspects conductive hearing loss. Which could
contribute to this? - Cerumen, commonly called earwax, is a combination of secretions and sloughed
epithelial cells that protects the ears from infection, water, and insects. It is normally expelled from the ear
canal through natural jaw movement. When this self-cleaning process fails, cerumen can become impacted.
Cerumen impaction occludes the ear canal and can press against the tympanic membrane, resulting in
conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive
hearing loss is caused by problems in the external and middle ear that interfere with the transmission of
sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of
the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and
osteomas.
