NSG 6440 Question 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
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.
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
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)
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
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
Order blood cultures
Stop aspirin and reassess in 1 week
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
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.
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
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)
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
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
Order blood cultures
Stop aspirin and reassess in 1 week
