NSG 6440 Dermatological disorders Q-Bank Questions and
Rationales
1. A patient with diabetes has right anterior shin edema, erythema, warmth, and
tenderness to touch. This developed over the past 3 days. There is no visible pus. What
is the most likely diagnosis to consider?
Deep vein thrombosis (DVT)
Buerger’s disease
Cellulitis Correct
Venous disease
Rationale:
This description is one of cellulitis. Cellulitis involves an infection of the
subcutaneous layers of the skin. It must be treated with an oral antibiotic. In a patient
with diabetes, it is particularly important to identify, and aggressively treat cellulitis
early, because elevated blood sugar levels will make eradication more difficult.
Buerger’s disease involves inflammation of the medium-sized arteries and does not
present on the anterior shin only. DVT seldom presents on the anterior shin, so this is
not likely. Venous disease does not present acutely, as in this situation.
2. An example of a first-generation cephalosporin used to treat a skin infection is:
cephalexin. Correct
cefuroxime.
cefdinir.
cefaclor.
Rationale:
Two common first-generation cephalosporins used to treat skin and skin structure
infections are cephalexin and cefadroxil. These are taken two to four times daily and
are generally well tolerated. These antibiotics provide coverage against
Staphylococcus and Streptococcus, common skin pathogens.
3. A patient reports that he found a tick on himself about 2 weeks ago. He presents today
with a red circle and a white center near where he remembers the tick bite. He did not
, seek treatment at that time. Today he complains of myalgias and arthralgias. Which
laboratory test can be used to help diagnose Lyme disease?
CBC
Lyme titer
ELISA Correct
Skin scraping
Explanation:
A detailed history should always precede testing for Lyme disease. The red circle with
the white center is likely erythema migrans (EM). EM is the characteristic skin lesion of
Lyme disease (and other illnesses) and usually occurs within 1 month following the tick
bite. Many learned authorities, including the Infectious Diseases Society of America,
conclude that individuals should not be screened/tested for Lyme disease unless they
have a high probability of having Lyme disease. In this case, historical features coupled
with physical exam support the diagnosis, and thus screening. The most common initial
serologic test for screening is an ELISA. If it is positive, it should be confirmed with a
Western blot. Unfortunately, there are a large number of false positives and so a
confirmation should be performed.
4. A 16-year-old male has nodulocystic acne. What might have the greatest positive
impact in managing his acne?
Retin-A plus minocycline
Benzoyl peroxide plus erythromycin
Isotretinoin (Accutane) Correct
Oral antibiotics
Rationale:
Nodulocystic acne is the most severe form of acne vulgaris. Nodules and cysts
characterize this disease. They can be palpated and usually seen on the skin, although
they actually are under the skin’s surface. They develop when the follicle wall
ruptures and leaks pus and cell contents into the dermis. The contaminated material
infects adjoining follicles and the nodule develops. Isotretinoin is the only known
effective treatment.
5. A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent
with this?
, Clue cells
Scabies
Hyphae Correct
Leukocytes
Rationale:
A Wood’s lamp emits ultraviolet light when turned on. If an area fluoresces under
Wood’s lamp illumination, a fungal (and sometimes bacterial) infection should be
suspected. Hyphae are associated with fungal infections. The test is most effectively
performed in a darkened room so the fluorescence can be more easily identified.
Deodorant, soap, and makeup may also fluoresce. About one-third of hyphae
fluoresce.
6. A patient exhibits petechiae on both lower legs but has no other complaints. How
should the NP proceed?
Refer to hematology
Order a CBC Correct
Order blood cultures
Stop aspirin and reassess in 1 week
Rationale:
The presence of petechiae on the lower legs (or anywhere on the body) should prompt
the NP to consider a problem that is related to a low platelet count. A CBC should be
checked to assess the platelet count and for any evidence of anemia from blood loss.
If the platelet count is found to be low, referral to hematology should be done. Blood
cultures are of no value in this patient, who is otherwise asymptomatic.
7. A 6-year-old patient with sore throat has coryza, hoarseness, and diarrhea. What is the
likely etiology?
Group A Streptococcus
H. parainfluenzae
Viral etiology Correct
Mycoplasma
Rationale:
, This constellation of symptoms is typical of a viral infection. Group A Streptococcus
is usually not accompanied by coryza. H. parainfluenzae is not a common cause of
pharyngitis. Mycoplasma usually is associated with lower respiratory tract infections.
8. The nurse practitioner examines a patient who has had poison ivy for 3 days. She asks
if she can spread it to her family members. The nurse practitioner replies:
“Yes, but only before crusting has occurred.”
“Yes, the fluid in the blister can transmit it.”
“No, transmission does not occur from the blister’s contents.” Correct
“No, you are no longer contagious.”
Rationale:
The skin reaction seen after exposure to poison ivy (or any other skin irritant), takes
place because of contact with the offending substance. In the case of poison ivy, the
harmful exposure occurs from contact with oil from the plant. The eruptions seen are
NOT able to transmit the reaction to other people unless oil from the plant remains on
the skin and someone touches the oil. The fluid found in the blisters is NOT able to
transmit poison ivy to anyone; only the oil from the plant can do that. After oil has
touched the skin, some time must pass for the reaction to occur. Therefore, reaction
times vary depending on skin thickness and quantity of oil contacting the skin.
9. A 74-year-old woman is diagnosed with shingles. The NP is deciding how to best
manage her care. What should be prescribed?
An oral antiviral agent Correct
An oral antiviral agent plus an oral steroid
An oral antiviral agent plus a topical steroid
A topical steroid only
Rationale:
An oral antiviral agent such as acyclovir, famciclovir or valacyclovir should be
prescribed, especially if it can be initiated within 72 hours after the onset of
symptoms. The addition of oral corticosteroids to oral antiviral therapy demonstrates
only modest benefit. Adverse events to therapy are more commonly reported in
patients receiving oral corticosteroids. There is no evidence that corticosteroid
therapy decreases the incidence or duration of postherpetic neuralgia or improved
quality of life. Corticosteroids should be limited to use in patients with acute neuritis
who have not derived benefit from opioid analgesics.
10. When can a child with chickenpox return to daycare?
24 hours after he is fever-free
Rationales
1. A patient with diabetes has right anterior shin edema, erythema, warmth, and
tenderness to touch. This developed over the past 3 days. There is no visible pus. What
is the most likely diagnosis to consider?
Deep vein thrombosis (DVT)
Buerger’s disease
Cellulitis Correct
Venous disease
Rationale:
This description is one of cellulitis. Cellulitis involves an infection of the
subcutaneous layers of the skin. It must be treated with an oral antibiotic. In a patient
with diabetes, it is particularly important to identify, and aggressively treat cellulitis
early, because elevated blood sugar levels will make eradication more difficult.
Buerger’s disease involves inflammation of the medium-sized arteries and does not
present on the anterior shin only. DVT seldom presents on the anterior shin, so this is
not likely. Venous disease does not present acutely, as in this situation.
2. An example of a first-generation cephalosporin used to treat a skin infection is:
cephalexin. Correct
cefuroxime.
cefdinir.
cefaclor.
Rationale:
Two common first-generation cephalosporins used to treat skin and skin structure
infections are cephalexin and cefadroxil. These are taken two to four times daily and
are generally well tolerated. These antibiotics provide coverage against
Staphylococcus and Streptococcus, common skin pathogens.
3. A patient reports that he found a tick on himself about 2 weeks ago. He presents today
with a red circle and a white center near where he remembers the tick bite. He did not
, seek treatment at that time. Today he complains of myalgias and arthralgias. Which
laboratory test can be used to help diagnose Lyme disease?
CBC
Lyme titer
ELISA Correct
Skin scraping
Explanation:
A detailed history should always precede testing for Lyme disease. The red circle with
the white center is likely erythema migrans (EM). EM is the characteristic skin lesion of
Lyme disease (and other illnesses) and usually occurs within 1 month following the tick
bite. Many learned authorities, including the Infectious Diseases Society of America,
conclude that individuals should not be screened/tested for Lyme disease unless they
have a high probability of having Lyme disease. In this case, historical features coupled
with physical exam support the diagnosis, and thus screening. The most common initial
serologic test for screening is an ELISA. If it is positive, it should be confirmed with a
Western blot. Unfortunately, there are a large number of false positives and so a
confirmation should be performed.
4. A 16-year-old male has nodulocystic acne. What might have the greatest positive
impact in managing his acne?
Retin-A plus minocycline
Benzoyl peroxide plus erythromycin
Isotretinoin (Accutane) Correct
Oral antibiotics
Rationale:
Nodulocystic acne is the most severe form of acne vulgaris. Nodules and cysts
characterize this disease. They can be palpated and usually seen on the skin, although
they actually are under the skin’s surface. They develop when the follicle wall
ruptures and leaks pus and cell contents into the dermis. The contaminated material
infects adjoining follicles and the nodule develops. Isotretinoin is the only known
effective treatment.
5. A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent
with this?
, Clue cells
Scabies
Hyphae Correct
Leukocytes
Rationale:
A Wood’s lamp emits ultraviolet light when turned on. If an area fluoresces under
Wood’s lamp illumination, a fungal (and sometimes bacterial) infection should be
suspected. Hyphae are associated with fungal infections. The test is most effectively
performed in a darkened room so the fluorescence can be more easily identified.
Deodorant, soap, and makeup may also fluoresce. About one-third of hyphae
fluoresce.
6. A patient exhibits petechiae on both lower legs but has no other complaints. How
should the NP proceed?
Refer to hematology
Order a CBC Correct
Order blood cultures
Stop aspirin and reassess in 1 week
Rationale:
The presence of petechiae on the lower legs (or anywhere on the body) should prompt
the NP to consider a problem that is related to a low platelet count. A CBC should be
checked to assess the platelet count and for any evidence of anemia from blood loss.
If the platelet count is found to be low, referral to hematology should be done. Blood
cultures are of no value in this patient, who is otherwise asymptomatic.
7. A 6-year-old patient with sore throat has coryza, hoarseness, and diarrhea. What is the
likely etiology?
Group A Streptococcus
H. parainfluenzae
Viral etiology Correct
Mycoplasma
Rationale:
, This constellation of symptoms is typical of a viral infection. Group A Streptococcus
is usually not accompanied by coryza. H. parainfluenzae is not a common cause of
pharyngitis. Mycoplasma usually is associated with lower respiratory tract infections.
8. The nurse practitioner examines a patient who has had poison ivy for 3 days. She asks
if she can spread it to her family members. The nurse practitioner replies:
“Yes, but only before crusting has occurred.”
“Yes, the fluid in the blister can transmit it.”
“No, transmission does not occur from the blister’s contents.” Correct
“No, you are no longer contagious.”
Rationale:
The skin reaction seen after exposure to poison ivy (or any other skin irritant), takes
place because of contact with the offending substance. In the case of poison ivy, the
harmful exposure occurs from contact with oil from the plant. The eruptions seen are
NOT able to transmit the reaction to other people unless oil from the plant remains on
the skin and someone touches the oil. The fluid found in the blisters is NOT able to
transmit poison ivy to anyone; only the oil from the plant can do that. After oil has
touched the skin, some time must pass for the reaction to occur. Therefore, reaction
times vary depending on skin thickness and quantity of oil contacting the skin.
9. A 74-year-old woman is diagnosed with shingles. The NP is deciding how to best
manage her care. What should be prescribed?
An oral antiviral agent Correct
An oral antiviral agent plus an oral steroid
An oral antiviral agent plus a topical steroid
A topical steroid only
Rationale:
An oral antiviral agent such as acyclovir, famciclovir or valacyclovir should be
prescribed, especially if it can be initiated within 72 hours after the onset of
symptoms. The addition of oral corticosteroids to oral antiviral therapy demonstrates
only modest benefit. Adverse events to therapy are more commonly reported in
patients receiving oral corticosteroids. There is no evidence that corticosteroid
therapy decreases the incidence or duration of postherpetic neuralgia or improved
quality of life. Corticosteroids should be limited to use in patients with acute neuritis
who have not derived benefit from opioid analgesics.
10. When can a child with chickenpox return to daycare?
24 hours after he is fever-free
