UTICA COLLEGE NUR 621 FINAL EXAM - LATEST
2026/2027
Question Bank - 220 Questions with Answers and
Rationales
SECTION 1: DERMATOLOGY
QUESTION 1
A 62-year-old patient presents with a wide, diffuse area of erythematous skin on their lower
left leg that is warm and tender to palpation with edema present. What is the most likely
diagnosis?
Answer: Cellulitis
Rationale: Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue
characterized by diffuse erythema, warmth, tenderness, and edema. Diabetic ulcers present
as localized open sores rather than diffuse erythema. Necrotizing fasciitis would present
with severe pain out of proportion to examination findings and rapid progression with
systemic toxicity. Kaposi's sarcoma, associated with HIV/AIDS, presents as purple-red
nodules or plaques rather than acute warmth and tenderness.
QUESTION 2
A patient presents with a rubbery, smooth, round mass on their chest that is compressible
and has a soft-to-very-firm texture. What is the most likely diagnosis?
Answer: Lipoma
Rationale: A lipoma is a benign tumor of adipose tissue characterized as rubbery, smooth,
round, compressible, and mobile under the skin. Adenomas are benign glandular tumors
typically found in internal organs rather than as subcutaneous chest masses. Nevi are
pigmented moles that are not compressible. Skin tags (acrochordons) are soft, pedunculated
growths that are not deep or compressible.
QUESTION 3
When staging malignant melanoma using Clark's levels, which level indicates invasion into
the reticular dermis?
Answer: Level IV
,Rationale: Clark's levels of melanoma invasion are defined as: Level I - Confined to epidermis
(in situ); Level II - Invades papillary dermis; Level III - Fills papillary dermis but does not
extend into reticular dermis; Level IV - Invades reticular dermis; Level V - Invades
subcutaneous tissue.
QUESTION 4
A 22-year-old patient presents with round, hypopigmented macules with fine scaling on the
back. What is the most likely diagnosis?
Answer: Tinea versicolor
Rationale: Tinea versicolor (pityriasis versicolor) is a superficial fungal infection caused by
Malassezia species. Classic findings include round or oval hypopigmented or
hyperpigmented macules with fine scaling, typically on the back, chest, shoulders, or neck.
Red papules on the face suggest acne, rosacea, or folliculitis. Crusted plaques in the groin
area are more consistent with tinea cruris.
QUESTION 5
Which scalp problem can be caused by fever and certain drugs?
Answer: Telogen effluvium
Rationale: Telogen effluvium is diffuse, temporary hair shedding that occurs when a large
number of hairs shift into the telogen (resting) phase. Triggers include fever, illness, surgery,
childbirth, medications, and stress. Alopecia areata is an autoimmune condition causing
patchy hair loss. Psoriasis presents with scaly, erythematous plaques and is not triggered by
fever or drugs. Trichotillomania is compulsive hair pulling.
QUESTION 6
Which of the following statements about performing cryosurgery for actinic keratosis is
true?
Answer: The "freeze balls" should be approximately one-and-a-half times as wide as they are
deep.
Rationale: In cryosurgery for actinic keratosis, the ice ball (freeze zone) should extend about
1.5 times wider than the lesion's depth to ensure adequate tissue destruction while
minimizing damage to surrounding healthy tissue. Biopsy is not required for every lesion; it
is only indicated when diagnosis is uncertain or malignancy is suspected. Overfreezing
increases scarring risk, and typical freeze time is 5-10 seconds, not 30 seconds.
QUESTION 7
,Which skin manifestation is characterized by infraorbital folds in a patient with atopic
dermatitis?
Answer: Dennie-Morgan lines
Rationale: Dennie-Morgan lines are extra infraorbital folds under the lower eyelids
frequently seen in patients with atopic dermatitis due to chronic rubbing and itching.
Pityriasis alba presents as hypopigmented patches on the face and is common in atopic
children but not specific to infraorbital folds. Keratoconus is corneal thinning (ocular finding,
not skin), and keratosis pilaris presents as rough follicular papules on arms and thighs.
QUESTION 8
A patient presents with xerosis. Which statement about this condition is correct?
Answer: It can be a side effect of depigmentation creams.
Rationale: Xerosis is abnormally dry skin that is very common in the elderly due to decreased
skin lipids, not uncommon. Depigmentation creams (such as hydroquinone, corticosteroids,
and retinoids) can cause dryness as a side effect. Strong deodorants typically worsen
dryness, and daily hot baths strip natural oils and exacerbate xerosis rather than soothing
the skin.
QUESTION 9
What is the most appropriate teaching point for a patient prescribed tretinoin for acne?
Answer: Apply at bedtime over the affected area.
Rationale: Tretinoin should be applied at bedtime to minimize sun sensitivity and
photodegradation. It should be applied sparingly over the affected area, not as a thick layer,
and generally not on open lesions. Erythema and fine scaling are expected irritant effects
rather than abnormal reactions.
QUESTION 10
A patient presents with a suspicious skin lesion. What feature is most concerning for
melanoma?
Answer: Asymmetry, irregular borders, multiple colors, diameter >6mm, and
evolving/changing
Rationale: The ABCDE criteria for melanoma assessment are: Asymmetry, Border irregularity,
Color variation (multiple colors), Diameter >6mm, and Evolving or changing lesion. The
presence of these features should prompt biopsy and further evaluation.
QUESTION 11
, Which type of skin cancer is most commonly associated with chronic sun exposure?
Answer: Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) is strongly associated with cumulative lifetime sun
exposure and UV damage. Basal cell carcinoma is also sun-related but more commonly
occurs on areas with intermittent intense exposure. Melanoma is associated with
intermittent intense exposure and sunburns. Actinic keratosis is a precursor lesion to SCC.
QUESTION 12
A patient with psoriasis is prescribed topical corticosteroids. What is the most important
adverse effect to monitor?
Answer: Skin atrophy and striae
Rationale: Topical corticosteroids, especially with prolonged use or high potency, can cause
skin atrophy, striae, telangiectasia, and systemic absorption. Patients should be counseled to
use the lowest effective potency for the shortest duration necessary.
QUESTION 13
What is the characteristic lesion of impetigo?
Answer: Honey-colored crusted lesions
Rationale: Impetigo is a superficial bacterial skin infection, most commonly caused by
Staphylococcus aureus or Streptococcus pyogenes. It presents with honey-colored, crusted
lesions typically on the face and extremities. Unlike cellulitis, it does not involve deeper
tissues.
QUESTION 14
A patient presents with painful, grouped vesicles on an erythematous base on the right
lower back. What is the most likely diagnosis?
Answer: Herpes zoster (shingles)
Rationale: Herpes zoster presents with painful, unilateral, grouped vesicles in a dermatomal
distribution. It results from reactivation of the varicella-zoster virus. The condition is more
common in older adults and immunocompromised individuals. Antiviral therapy within 72
hours of rash onset is recommended.
QUESTION 15
What is the first-line treatment for widespread tinea corporis?
2026/2027
Question Bank - 220 Questions with Answers and
Rationales
SECTION 1: DERMATOLOGY
QUESTION 1
A 62-year-old patient presents with a wide, diffuse area of erythematous skin on their lower
left leg that is warm and tender to palpation with edema present. What is the most likely
diagnosis?
Answer: Cellulitis
Rationale: Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue
characterized by diffuse erythema, warmth, tenderness, and edema. Diabetic ulcers present
as localized open sores rather than diffuse erythema. Necrotizing fasciitis would present
with severe pain out of proportion to examination findings and rapid progression with
systemic toxicity. Kaposi's sarcoma, associated with HIV/AIDS, presents as purple-red
nodules or plaques rather than acute warmth and tenderness.
QUESTION 2
A patient presents with a rubbery, smooth, round mass on their chest that is compressible
and has a soft-to-very-firm texture. What is the most likely diagnosis?
Answer: Lipoma
Rationale: A lipoma is a benign tumor of adipose tissue characterized as rubbery, smooth,
round, compressible, and mobile under the skin. Adenomas are benign glandular tumors
typically found in internal organs rather than as subcutaneous chest masses. Nevi are
pigmented moles that are not compressible. Skin tags (acrochordons) are soft, pedunculated
growths that are not deep or compressible.
QUESTION 3
When staging malignant melanoma using Clark's levels, which level indicates invasion into
the reticular dermis?
Answer: Level IV
,Rationale: Clark's levels of melanoma invasion are defined as: Level I - Confined to epidermis
(in situ); Level II - Invades papillary dermis; Level III - Fills papillary dermis but does not
extend into reticular dermis; Level IV - Invades reticular dermis; Level V - Invades
subcutaneous tissue.
QUESTION 4
A 22-year-old patient presents with round, hypopigmented macules with fine scaling on the
back. What is the most likely diagnosis?
Answer: Tinea versicolor
Rationale: Tinea versicolor (pityriasis versicolor) is a superficial fungal infection caused by
Malassezia species. Classic findings include round or oval hypopigmented or
hyperpigmented macules with fine scaling, typically on the back, chest, shoulders, or neck.
Red papules on the face suggest acne, rosacea, or folliculitis. Crusted plaques in the groin
area are more consistent with tinea cruris.
QUESTION 5
Which scalp problem can be caused by fever and certain drugs?
Answer: Telogen effluvium
Rationale: Telogen effluvium is diffuse, temporary hair shedding that occurs when a large
number of hairs shift into the telogen (resting) phase. Triggers include fever, illness, surgery,
childbirth, medications, and stress. Alopecia areata is an autoimmune condition causing
patchy hair loss. Psoriasis presents with scaly, erythematous plaques and is not triggered by
fever or drugs. Trichotillomania is compulsive hair pulling.
QUESTION 6
Which of the following statements about performing cryosurgery for actinic keratosis is
true?
Answer: The "freeze balls" should be approximately one-and-a-half times as wide as they are
deep.
Rationale: In cryosurgery for actinic keratosis, the ice ball (freeze zone) should extend about
1.5 times wider than the lesion's depth to ensure adequate tissue destruction while
minimizing damage to surrounding healthy tissue. Biopsy is not required for every lesion; it
is only indicated when diagnosis is uncertain or malignancy is suspected. Overfreezing
increases scarring risk, and typical freeze time is 5-10 seconds, not 30 seconds.
QUESTION 7
,Which skin manifestation is characterized by infraorbital folds in a patient with atopic
dermatitis?
Answer: Dennie-Morgan lines
Rationale: Dennie-Morgan lines are extra infraorbital folds under the lower eyelids
frequently seen in patients with atopic dermatitis due to chronic rubbing and itching.
Pityriasis alba presents as hypopigmented patches on the face and is common in atopic
children but not specific to infraorbital folds. Keratoconus is corneal thinning (ocular finding,
not skin), and keratosis pilaris presents as rough follicular papules on arms and thighs.
QUESTION 8
A patient presents with xerosis. Which statement about this condition is correct?
Answer: It can be a side effect of depigmentation creams.
Rationale: Xerosis is abnormally dry skin that is very common in the elderly due to decreased
skin lipids, not uncommon. Depigmentation creams (such as hydroquinone, corticosteroids,
and retinoids) can cause dryness as a side effect. Strong deodorants typically worsen
dryness, and daily hot baths strip natural oils and exacerbate xerosis rather than soothing
the skin.
QUESTION 9
What is the most appropriate teaching point for a patient prescribed tretinoin for acne?
Answer: Apply at bedtime over the affected area.
Rationale: Tretinoin should be applied at bedtime to minimize sun sensitivity and
photodegradation. It should be applied sparingly over the affected area, not as a thick layer,
and generally not on open lesions. Erythema and fine scaling are expected irritant effects
rather than abnormal reactions.
QUESTION 10
A patient presents with a suspicious skin lesion. What feature is most concerning for
melanoma?
Answer: Asymmetry, irregular borders, multiple colors, diameter >6mm, and
evolving/changing
Rationale: The ABCDE criteria for melanoma assessment are: Asymmetry, Border irregularity,
Color variation (multiple colors), Diameter >6mm, and Evolving or changing lesion. The
presence of these features should prompt biopsy and further evaluation.
QUESTION 11
, Which type of skin cancer is most commonly associated with chronic sun exposure?
Answer: Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) is strongly associated with cumulative lifetime sun
exposure and UV damage. Basal cell carcinoma is also sun-related but more commonly
occurs on areas with intermittent intense exposure. Melanoma is associated with
intermittent intense exposure and sunburns. Actinic keratosis is a precursor lesion to SCC.
QUESTION 12
A patient with psoriasis is prescribed topical corticosteroids. What is the most important
adverse effect to monitor?
Answer: Skin atrophy and striae
Rationale: Topical corticosteroids, especially with prolonged use or high potency, can cause
skin atrophy, striae, telangiectasia, and systemic absorption. Patients should be counseled to
use the lowest effective potency for the shortest duration necessary.
QUESTION 13
What is the characteristic lesion of impetigo?
Answer: Honey-colored crusted lesions
Rationale: Impetigo is a superficial bacterial skin infection, most commonly caused by
Staphylococcus aureus or Streptococcus pyogenes. It presents with honey-colored, crusted
lesions typically on the face and extremities. Unlike cellulitis, it does not involve deeper
tissues.
QUESTION 14
A patient presents with painful, grouped vesicles on an erythematous base on the right
lower back. What is the most likely diagnosis?
Answer: Herpes zoster (shingles)
Rationale: Herpes zoster presents with painful, unilateral, grouped vesicles in a dermatomal
distribution. It results from reactivation of the varicella-zoster virus. The condition is more
common in older adults and immunocompromised individuals. Antiviral therapy within 72
hours of rash onset is recommended.
QUESTION 15
What is the first-line treatment for widespread tinea corporis?
