A. Newborns
B. Young children
C. Adolescents
D. Older adults: A: CorrectMilia are small, whitish, discrete papules on the face;
they are commonly found during the first 2 to 3 months of life. The sebaceous
glands function in an immature fashion at this age and are easily plugged by sebum.
Answers b, c, and d are incorrect.
2. Mr. Babson is a 74-year-old man who presents to your office with a com-
plaint of a "spot" on his chin and wants to know whether it is cancerous.
Which of the following signs or symptoms indicates a need for further medical
investigation?
A. The "spot" is a reddish brown color.
B. The "spot" has been on his chin for 20 years.
C. The "spot" bleeds easily when it is touched.
D. The "spot" is slightly raised and circumscribed.: C: CorrectA "spot" that
bleeds easily when it is touched may be indicative of a more serious condition like
basal cell carcinoma, the most common form of skin cancer.
3. A 6-year-old girl has freckles over her nose and cheeks. The examiner will
recall that freckles are a type of:
A. macule.
B. papule.
C. nodule.
D. patch.: A:correctA macule is a flat, circumscribed area that is a change in the
color of the skin usually less than 1 cm in diameter. Freckles, flat moles, petechiae,
and measles are examples of macules.
,4. Mrs. Tomberg brings her 4-day-old infant to your office with a concern of
a yellowish skin tone. Which of the following statements best describes the
rationale for the skin tone?
A. Increased formation of subcutaneous tissue causes a yellow hue.
B. Capillaries broken during the birth process turn the skin slightly yellow as
bruises heal.
C. The yellowish color results from increased fat metabolism and heat produc-
tion.
D. The infant has hyperbilirubinemia.: D:CorrectHyperbilirubinemia, or physiolog-
,ic jaundice, is present to a mild degree in many newborn infants. It usually starts
after the first day of life and disappears by the eighth to tenth day but may persist
for as long as 3 to 4 weeks. Intense and persistent jaundice suggests liver disease,
a hemolytic process, or severe, overwhelming infection.
5. Mr. Russel is a 17-year-old adolescent patient who presents with a complaint
of acne. He asks the examiner why teens have more problems with acne than
children. Which of the following would be an appropriate response?
A. "Children have better hygiene habits than adolescents because of parental
guidance."
B. "Adolescents have reduced blood flow to the epidermal layer of the skin,
making them more prone to infections."
C. "At puberty, adolescents begin to secrete more oil from sebaceous glands."
D. "Children have very little skin mass, which prevents development of acne."-
: C: CorrectDuring adolescence, the apocrine glands enlarge and become active,
causing increased axillary sweating and sometimes body odor. Sebaceous glands
increase sebum production in response to increased hormone levels, primarily
androgen, giving the skin an oily appearance and predisposing the individual to
acne.
6. While examining the skin of an 87-year-old woman, the nurse observes
significant tenting. Which of the following best explains that finding?
A. Small tags of skin form on the neck.
B. The skin becomes thin and takes on a parchment-like appearance.
C. The skin becomes dry with significant flaking.
D. There is a loss of adipose tissue and elasticity.: D:CorrectTenting occurs in the
older adult as a result of loss of adipose tissue and elasticity. The skin often appears
to hang loosely on the bony frame as a result of a general loss of elasticity, loss of
underlying adipose tissue, and years of gravitational pull.
7. Mr. Allen is a 66-year-old man who presents to your clinic for follow-up for
his chronic obstructive pulmonary disease (COPD). When assessing for the
presence of clubbing, the examiner specifically examines:
A. the width of the nail base.
B. the angle of the nail base.
C. the thickness of the nail.
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, D. the color of the nail.: B:CorrectThe average nail base angle should
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measure 160 degrees. In clubbing, the nail base is boggy and the angle
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increases and ap- proaches or exceeds 180 degrees. Another method of
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assessment is the Schamroth technique. Clubbing is associated with a variety
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of respiratory and cardiovascular diseases, cirrhosis, colitis, and thyroid
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disease.
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8. Mrs. Jones presents with a complaint of a spot on her skin. Which
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type of lesion can develop in an already present nevi?
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A. Malignant melanoma nn
B. Squamous cell carcinoma nn nn
C. Basal cell carcinoma nn nn
D. Kaposi sarcoma: A: CorrectMalignant melonoma is the most lethal form
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of skin cancer that develops from melanocytes. Squamous cell carcinoma,
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basal cell carcinoma, and Kaposi sarcoma rarely develop in an already
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existing nevi.
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9. Mrs. Xavier is a 45-year-old patient who presents to your office with a
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complaint of a rash. On examination, you find a herald patch (round
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plaque with fine superficial scaling). Which of the following conditions
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identifies this finding?
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A. Pityriasis rosea nn
B. Dermatophytosis
C. Rosacea
D. Herpes zoster: A:CorrectPityriasis rosea is a self-limiting inflammation of
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un- known cause. The herald lesion is commonly missed, although the most
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common sign of this condition.
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10. The examiner notes a large blue-black spot on the buttock of a 4-week-
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old black neonate. The mother states that the infant was born with it. The
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examiner should recognize that this:
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A. is an expected finding.
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B. may indicate child abuse. nn nn nn
C. is related to birth trauma.
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D. suggests a congenital defect.: A:CorrectThis finding is indicative of
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Mongolian spots. Mongolian spots are irregular areas of deep blue
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pigmentation, usually in the sacral and gluteal regions, and are seen
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predominantly in newborns of African, Native American/American Indian, Asian,
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or Latin descent. They commonly appear on the back, buttocks, shoulders,
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and legs of well babies and usually disappear in the preschool years.
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