NUR631 FINAL EXAM NEW MATERIAL QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

NUR631 FINAL EXAM NEW MATERIAL QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. Dermatophytes Correct Answer A type of fungus or tinea are superficial skin infections caused predominantly by three fungal species: Trichophyton, epidermophyton, and Microsporum Incidence: affects people of all ages, race and genders, more common in tropical climates, warmer months in temperature climates - more common in immunocompromised people including secondary use of topical steroids. Risk factors: heat and humidity, obesity, immunocompromised, diabetics - diabetics have higher risk of having tinea or dermatophyte infections age--> need to look at comorbidities like diabetes, PVD, a broken skin, or hair shaft, if they cohabitate with others and could have yeast infections or candida infections 2. Tinea capitis (scalp ringworm) Correct Answer spread direct contact with the lesion, sharing of personal items. - common in children (toddlers, school aged children from urban areas) Most contagious out of all of the dermatophytes Clinical presentation: - Black dot tinea capitis presents with painless patchy alopecia can be single or multiple patches, no erythema present. the black dot appearance results from broken hair stubbles that remain on scalp - Gray patch tinea capitis child with this condition also presents with patchy alopecia but bald patches are covered with fine grey white scales. Made up of thick keratinized skin that is grey white in color - extremely painful and inflammatory part of tinea capitis is the kerion is a large bright red boggy bump on scalp with alopecia, purulent drainage can be expressed, this can result in scarring alopecia 3. Diagnosis/tx of tinea capitis Correct Answer examination of hair and skin scrapings - fungal culture- woods lamp Tx: systemic anti-fungals are gold standard!! - Griseofulvin (Grifulvin v) 250-500mg BID FIRST LINE** --> need to monitor renal and hepatic, hematopoietic function. Tx is 2-4 months long. --> decreases effectiveness of oral contraceptives, oral anticoagulants and barbiturates, teratogenic to sperm - Terbinafine - Itraconazole - concurrent tx with selenium sulfide shampoo three times per week is used as adjunctive therapy to systemic antifungals4. Tinea Corporis (Body ringworm): Clinical Presentation: - erythematous round and elevated pruritic lesion that grows in size and starts to clear in the center - found on body in most cases seen on flank - scaling pruritic plaques, characterized by sharply defined anulopatent with peripheral activity and central clearing. Diagnostics: Skin scrapings and under microscope see fungal hypahe in dermis 5. Treatment Tinea corporis (body ringworm) Correct Answer Mild cases: Topical antifungal - Clotrimazole (Lotrimin) - Terbinafine Cream 1% (lamisil) QD for 1 week - Ketoconazole 2% Cream (Nizoral) BID daily for 2-3 weeks, to prevent releapse continue use for one more week after.- concomitant short term tx with mild corticosteroid such as hydrocortisone 1% is effective in helping to relieve itching and inflammation. Severe: Systemic antifungals - Itraconazole (Sporonox) - Terbinafine (lamisil) - Griseofulvin (Grifulfin V) 6. Tinea Cruris (Jock itch) Correct Answer groin area has macerated appearance (Lichenification) - how is it different from candida intertrigo? spares the testicles and scrotum, it is on one side whereas candida intertrigo involves the scrotum Risk factors: Warm, Moist areas, Sweating, Obese people. multiple layers of clothing Clinical Presentation: Extremely Pruritic - round to half circle and will spread to inner medial upper thigh but spare the scrotum - color will vary from bright red to dull discoloration - lesions can become macerated from infection and scratching can become secondarily infected with bacteria or c. albicans 7. Treatment jock itch Correct Answer mild cases: topical antifungal - clotrimazole 1%(lotrimin) - Terbinafine 1% cream (Lamisil) QD for 1 week- Ketoconazole Cream 2% Severe: - Griseofulvin 500mg QD for 1-2 weeks (monitor LFTs) - Diflucan (Fluconazole) 150mg BID for 4 weeks. 8. Tinea Pedis (athletes foot) Correct Answer occurs more in males than females most common dermatophyte seen in practice - common with tinea mannum or ungum hand) or tinea cruris Clinical Presentation: - Macerated or soft whitened skin between the toes, infection is pruritic and has occasional fissures (starts in 3rd-4th toe most commonly) - multiple vesicles and bullae - usually bilateral - is a scaly rash that causes itching, stinging and burning - occurs in those with sweaty feet and especially in tight fit shoes 9. Tinea Pedis Dx/TX Correct Answer Made by clinical presentation, confirmed via microscopy and culture of primary skin TX: - mild cases topical antifungal: --clotrimazole (Lotrimin) --Terbinafine (Lamisil 1%) QD for 1 week -- Ketoconazole 2% cream Nizoral Severe Cases: - systemic antifungals --Itraconazole --Griseofulvin 10. Tinea Versicolor (pityriasis versicolor) Correct Answer is a a fungal yeast that colonizes all over the human skin - appearance of hyper or hypopigmented nummular macules - can be discrete, scattered or confluent patches - usually asymp but can be mildly pruritic - it is not seen as a dermatophyte infection, common in the geriatric population Clinical presentation: - located mainly on the back, chest and arms sometimes by neck and face- has a christmas tree like pattern